Determinanti della classe NYHA nel paziente anziano con scompenso cardiaco: ruolo della disfunzione diastolica, dell'insufficienza mitralica funzionale e dell'alterata ventilazione durante esercizio.

Translated title of the contribution: What underlies NYHA class in elderly patients with heart failure? Role of diastolic dysfunction, functional mitral regurgitation and abnormal ventilation during exercise

Gabriella Malfatto, Paola Cuoccio, Caterina Bizzi, Giovanna Branzi, Alessandra Villani, Francesco Della Rosa, Gianfranco Parati, Mario Facchini

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Color-Doppler ecocardiography and cardiopulmonary stress test are pivotal in the evaluation of patients with heart failure. Besides determining systolic function through left ventricular ejection fraction (EF), color-Doppler ecocardiography evaluates the presence and degree of functional mitral regurgitation and the severity of diastolic dysfunction. Moreover, in addition to the aerobic capacity indicated by peak O2 consumption, other parameters of cardiopulmonary stress have proven useful for diagnostic purposes, such as the peak VE/VCO2 ratio or ventilatory efficiency. Since in elderly patients with heart failure the functional impairment often is a combination of the effects of aging with those of disease, the relationship between symptoms, i.e. the NYHA class, ventricular pump function and aerobic performance is sometimes difficult to estabilish. MATERIALS AND METHODS: In 60 elderly with systolic heart failure (75 +/- 3 years, EF 30 +/- 6%), we correlated symptoms (i.e. NYHA class) with [1] degree of functional mitral regurgitation (FMR) determined by color-Doppler echocardiography; [2] degree of left ventricular diastolic dysfunction, measured by Doppler analysis of transmitralic and pulmonary veins flow; [3] VO2 and VE/VCO2 at peak exercise at cardiopulmonary test. RESULTS: In all patients, NYHA class was only weakly related with EF and peak VO2, with wide overlap of individual values among patients with different NYHA class. Instead, we observed a tight relationship between NYHA class, FMR degree, and severity of diastolic dysfunction and VE/VCO2 ratio at peak exercise (p

Original languageItalian
Pages (from-to)84-90
Number of pages7
JournalMonaldi Archives for Chest Disease - Cardiac Series
Volume72
Issue number2
Publication statusPublished - Jun 2009

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Mitral Valve Insufficiency
Ventilation
Heart Failure
Exercise
Exercise Test
Color
Doppler Color Echocardiography
Systolic Heart Failure
Ventricular Function
Pulmonary Veins
Left Ventricular Dysfunction
Stroke Volume

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

@article{8568dece5e7546cc8511ae50df2044b2,
title = "Determinanti della classe NYHA nel paziente anziano con scompenso cardiaco: ruolo della disfunzione diastolica, dell'insufficienza mitralica funzionale e dell'alterata ventilazione durante esercizio.",
abstract = "BACKGROUND: Color-Doppler ecocardiography and cardiopulmonary stress test are pivotal in the evaluation of patients with heart failure. Besides determining systolic function through left ventricular ejection fraction (EF), color-Doppler ecocardiography evaluates the presence and degree of functional mitral regurgitation and the severity of diastolic dysfunction. Moreover, in addition to the aerobic capacity indicated by peak O2 consumption, other parameters of cardiopulmonary stress have proven useful for diagnostic purposes, such as the peak VE/VCO2 ratio or ventilatory efficiency. Since in elderly patients with heart failure the functional impairment often is a combination of the effects of aging with those of disease, the relationship between symptoms, i.e. the NYHA class, ventricular pump function and aerobic performance is sometimes difficult to estabilish. MATERIALS AND METHODS: In 60 elderly with systolic heart failure (75 +/- 3 years, EF 30 +/- 6{\%}), we correlated symptoms (i.e. NYHA class) with [1] degree of functional mitral regurgitation (FMR) determined by color-Doppler echocardiography; [2] degree of left ventricular diastolic dysfunction, measured by Doppler analysis of transmitralic and pulmonary veins flow; [3] VO2 and VE/VCO2 at peak exercise at cardiopulmonary test. RESULTS: In all patients, NYHA class was only weakly related with EF and peak VO2, with wide overlap of individual values among patients with different NYHA class. Instead, we observed a tight relationship between NYHA class, FMR degree, and severity of diastolic dysfunction and VE/VCO2 ratio at peak exercise (p",
author = "Gabriella Malfatto and Paola Cuoccio and Caterina Bizzi and Giovanna Branzi and Alessandra Villani and {Della Rosa}, Francesco and Gianfranco Parati and Mario Facchini",
year = "2009",
month = "6",
language = "Italian",
volume = "72",
pages = "84--90",
journal = "Monaldi Archives for Chest Disease",
issn = "1122-0643",
publisher = "Fondazione Salvatore Maugeri",
number = "2",

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TY - JOUR

T1 - Determinanti della classe NYHA nel paziente anziano con scompenso cardiaco

T2 - ruolo della disfunzione diastolica, dell'insufficienza mitralica funzionale e dell'alterata ventilazione durante esercizio.

AU - Malfatto, Gabriella

AU - Cuoccio, Paola

AU - Bizzi, Caterina

AU - Branzi, Giovanna

AU - Villani, Alessandra

AU - Della Rosa, Francesco

AU - Parati, Gianfranco

AU - Facchini, Mario

PY - 2009/6

Y1 - 2009/6

N2 - BACKGROUND: Color-Doppler ecocardiography and cardiopulmonary stress test are pivotal in the evaluation of patients with heart failure. Besides determining systolic function through left ventricular ejection fraction (EF), color-Doppler ecocardiography evaluates the presence and degree of functional mitral regurgitation and the severity of diastolic dysfunction. Moreover, in addition to the aerobic capacity indicated by peak O2 consumption, other parameters of cardiopulmonary stress have proven useful for diagnostic purposes, such as the peak VE/VCO2 ratio or ventilatory efficiency. Since in elderly patients with heart failure the functional impairment often is a combination of the effects of aging with those of disease, the relationship between symptoms, i.e. the NYHA class, ventricular pump function and aerobic performance is sometimes difficult to estabilish. MATERIALS AND METHODS: In 60 elderly with systolic heart failure (75 +/- 3 years, EF 30 +/- 6%), we correlated symptoms (i.e. NYHA class) with [1] degree of functional mitral regurgitation (FMR) determined by color-Doppler echocardiography; [2] degree of left ventricular diastolic dysfunction, measured by Doppler analysis of transmitralic and pulmonary veins flow; [3] VO2 and VE/VCO2 at peak exercise at cardiopulmonary test. RESULTS: In all patients, NYHA class was only weakly related with EF and peak VO2, with wide overlap of individual values among patients with different NYHA class. Instead, we observed a tight relationship between NYHA class, FMR degree, and severity of diastolic dysfunction and VE/VCO2 ratio at peak exercise (p

AB - BACKGROUND: Color-Doppler ecocardiography and cardiopulmonary stress test are pivotal in the evaluation of patients with heart failure. Besides determining systolic function through left ventricular ejection fraction (EF), color-Doppler ecocardiography evaluates the presence and degree of functional mitral regurgitation and the severity of diastolic dysfunction. Moreover, in addition to the aerobic capacity indicated by peak O2 consumption, other parameters of cardiopulmonary stress have proven useful for diagnostic purposes, such as the peak VE/VCO2 ratio or ventilatory efficiency. Since in elderly patients with heart failure the functional impairment often is a combination of the effects of aging with those of disease, the relationship between symptoms, i.e. the NYHA class, ventricular pump function and aerobic performance is sometimes difficult to estabilish. MATERIALS AND METHODS: In 60 elderly with systolic heart failure (75 +/- 3 years, EF 30 +/- 6%), we correlated symptoms (i.e. NYHA class) with [1] degree of functional mitral regurgitation (FMR) determined by color-Doppler echocardiography; [2] degree of left ventricular diastolic dysfunction, measured by Doppler analysis of transmitralic and pulmonary veins flow; [3] VO2 and VE/VCO2 at peak exercise at cardiopulmonary test. RESULTS: In all patients, NYHA class was only weakly related with EF and peak VO2, with wide overlap of individual values among patients with different NYHA class. Instead, we observed a tight relationship between NYHA class, FMR degree, and severity of diastolic dysfunction and VE/VCO2 ratio at peak exercise (p

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