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European Journal of Echocardiography Advance Access originally published online on October 24, 2008
European Journal of Echocardiography 2009 10(3):400-405; doi:10.1093/ejechocard/jen297
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org.

Echocardiographic predictors of functional capacity in endomyocardial fibrosis patients

Vera M.C. Salemi1,*, João J. Leite2, Michael H. Picard3, Leila M. Oliveira2, Soraya F. Reis1, Jose L.B. Pena1 and Charles Mady1

1 Cardiomyopathy Unit, University of São Paulo Medical School
2 Pulmonary Division from Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
3 Cardiology Division and Cardiac Ultrasound Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

Received 29 April 2008; accepted after revision 5 October 2008; online publish-ahead-of-print 24 October 2008.

* Corresponding author. Tel/fax: +55 11 3556 9832.E-mail address: verasalemi{at}uol.com.br


  Abstract

Aims: Endomyocardial fibrosis (EMF) is a restrictive cardiomyopathy manifested mainly by diastolic heart failure. It is recognized that diastole is an important determinant of exercise capacity. The purpose of this study was to determine whether resting echocardiographic parameters might predict oxygen consumption (VO2p) by ergoespirometry and the prognostic role of functional capacity in EMF patients.

Methods and results: A total of 32 patients with biventricular EMF (29 women, 55.3 ± 11.4 years) were studied by echocardiography and ergoespirometry. The relationship between the echocardiographic indexes and the percentage of predicted VO2p (%VO2p) was investigated by the ‘stepwise’ linear regression analysis. The median VO2p was 11 ± 3 mL/kg/min and the %VO2p was 53 ± 9%. There was a correlation of %VO2p with an average of A' at four sites of the mitral annulus (A' peak, r = 0.471, P = 0.023), E'/A' of the inferior mitral annulus (r = –0.433, P = 0.044), and myocardial performance index (r = –0.352, P = 0.048). On multiple regression analysis, only A' peak was an independent predictor of %VO2p (%VO2p= 26.34 + 332.44 x A' peak). EMF patients with %VO2p< 53% had an increased mortality rate with a relative risk of 8.47.

Conclusion: In EMF patients, diastolic function plays an important role in determining the limitations to exercise and %VO2p has a prognostic value.

Keywords: Endomyocardial fibrosis; Restrictive cardiomyopathy; Echocardiography; Diastole; Ergoespirometry and prognosis


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