Aortic root systolic excursion and its association with exercise tolerance in patients with heart failure with preserved ejection fraction

Objective: We aimed to investigate the association between aortic root systolic excursion (ARSE) as a simple echocardiographic parameter and exercise tolerance in patients with heart failure with preserved ejection fraction (HFpEF). Methods: Eighty patients (mean age 57.9±10.5years) with HFpEF were compared with 80 with age and sex matched healthy subjects. Transthorathic echocardiography was performed with specific assessment of aortic root systolic excursion. Left ventricular longitudinal (LVGLS) and circumferential strain (LVGCS) were evaluated with speckle tracking imaging. In addition all participates underwent 6minute walking test (6MWT). Results: ARSE was reduced in subject with HFpEF compared with controls (p<0.05). Furthermore, HFpEF patients with 6MWTD<300m had pronounced decrease in ARSE compared with those with 6MWTD≥300m and control subjects (p<0.001). 6MWTD was correlated with ARSE (p<0.001), LVGLS (p<0.001) and LVGCS (p<0.01). ARSE had significant correlation with LVGLS (p<0.001) and LVGCS (p<0.003). Moreover, ARSE correlated negatively with LAVI (r =-0.438, p<0.001), E/e’ ratio (r =- 0.349, p<0.01). After multivariate analysis ARSE remained a strong independent predictor of exercise tolerance in patients with HFpEF (p<0.001). ROC analysis revealed that ARSE ≤7.5mm was the optimal cut-off value to predict reduced exercise intolerance in HFpEF patients (AUC=0.91; p<0.001). Conclusion: We found that, patients with HFpEF have reduced ARSE, which was significantly associated reduced 6MWTD. Reduced ARSE was correlated with subclinical LV systolic dysfunction and diastolic dysfunction. We suggest that ARSE, as a simple echocardiographic parameter might be of value, in order to better discriminate HFpEF patients risk profile.