Limited usefulness of resting hemodynamic assessments in predicting exercise capacity in hypertensive patients.

Kurpaska M; Krzesinski P; Gielerak G; Uzieblo-Zyczkowska B

Journal of Human Hypertension. 35(7):613-620, 2021 07. VI 1

Reliable assessments of reduced exercise capacity based on resting tests
are one of the major challenges in clinical practice. The aim of this
study was to evaluate the relationship between hemodynamic parameters
obtained via resting tests (echocardiography and impedance cardiography
(ICG)) and objective parameters of exercise capacity assessed via
cardiopulmonary exercise testing and exercise ICG in patients with
controlled arterial hypertension (AH). The left ventricular ejection
fraction (LVEF), global longitudinal strain (GLS), diastolic function
parameters (e’, E/A, E/e’), cardiac output (CO), stroke volume (SV), and
systemic vascular resistance index were evaluated for any correlations
with selected parameters of exercise capacity, such as peak oxygen uptake
(VO2) and peak CO in 93 people with AH (mean age 54 years, 47 women).
Statistically relevant correlations occurred between indices of exercise
capacity (peak VO2; peak CO) and only the following hemodynamic
parameters: diastolic blood pressure (R = 0.23, p = 0.026; R = 0.24, p =
0.021; respectively), e’ (R = 0.32, p = 0.002; R = 0.24, p = 0.027), E/e’
(R = 0.35, p < 0.001; ns), E/A (R = 0.23, p = 0.030; R = 0.21, p = 0.047),
SV at rest (ns; R = 0.24, p = 0.019), and CO at rest (ns; R = 0.21,
borderline p = 0.052). No significant correlations between the exercise
capacity parameters and either LVEF or GLS were observed. No hemodynamic
parameter proved to be an independent correlate of either peak VO2 or peak
CO. The association between hemodynamic parameters at rest and parameters
of exercise capacity was weak and limited to selected parameters of
diastolic function. Exercise capacity assessment in patients with AH based
on resting tests alone is insufficiently reliable and should be
supplemented with exercise tests.