© 1999 European Society of Cardiology
The influence of diastolic and systolic function on exercise performance in heart failure due to dilated cardiomyopathy or ischemic heart disease
Istituto di Cardiologia dell‘Universita’ degli Studi, Centro Cardiologico Fondazione Monzino, IRCCS, Centro di Studio per le Ricerche Cardiovascolari del Consiglio Nazionale delle Ricerche Milan, Italy
* Coressponding author. Istituto di Cardiologia, Via Parea 4, 20138 Milano, Italy. Tel.: +39 02 58011039; fax: +39 02 504667; e-mail: morago{at}imiucca.csi.unimi.it
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Abstract |
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Background: Peripheral adaptations and ventricular abnormalities influence physical performance in chronic heart failure. However, the role of the heart in determining exercise capacity has not been completely elucidated.
Aims: To define cardiac determinants of exercise capacity in patients with dilated cardiomyopathy.
Methods: In 101 patients with heart failure (NYHA class II–III) due to primary or ischemic dilated cardiomyopathy we measured peak exercise oxygen consumption (PVO2), left ventricular ejection fraction (EF), left and right atrial and ventricular cavity dimensions, mitral and tricuspid flows. Patients were subdivided in class A (PVO2>20 ml/min per kg; n=44), class B (PVO2 16–20 ml/min per kg; n=42) and class C (PVO2<16 ml/min per kg; n=15).
Results: Left ventricular diastolic and systolic dimensions, left atrial diameter, right atrial and ventricular areas were greater in class C than in class B and A; EF was lower in class C than in the other two classes; mitral peak flow velocity at early diastole (PFVE) and the ratio between early and late peak flow velocity (PFVE/PFVA) were higher in class C; mitral and tricuspid deceleration time (DT) in class B and A significantly exceeded those in class C. Peak VO2 was correlated with left and right ventricular dimensions, left atrial diameter, EF, mitral PFVE and PFVE/PFVA, mitral and tricuspid DT. Left ventricular EF, DT of the mitral valve and left ventricular diastolic diameter were independent predictors of peak VO2 at multivariate analysis.
Conclusions: In patients with dilated cardiomyopathy PVO2 is related to left and right ventricular dimensions, left and right ventricular filling pattern and EF. Both systolic and diastolic dysfunction influence functional capacity.
Key Words: Dilated cardiomyopathy • Oxygen consumption • Systolic and diastolic function
Accepted December 21, 1998
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