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The influence of diastolic and systolic function on exercise performance in heart failure due to dilated cardiomyopathy or ischemic heart disease
Author(s) -
Pepi Mauro,
Agostoni PierGiuseppe,
Marenzi GianCarlo,
Doria Elisabetta,
Guazzi Marco,
Lauri Gianfranco,
Maltagliati Anna,
Guazzi Maurizio
Publication year - 1999
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/s1388-9842(99)00003-3
Subject(s) - cardiology , medicine , heart failure , dilated cardiomyopathy , ejection fraction , diastole , mitral valve , blood pressure
Abstract 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 ( P v o 2 ), left ventricular ejection fraction (EF), left and right atrial and ventricular cavity dimensions, mitral and tricuspid flows. Patients were subdivided in class A ( P vo 2 >20 ml/min per kg; n =44), class B ( P vo 2 16–20 ml/min per kg; n =42) and class C ( P vo 2 <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 v o 2 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 vo 2 at multivariate analysis. Conclusions: In patients with dilated cardiomyopathy P vo 2 is related to left and right ventricular dimensions, left and right ventricular filling pattern and EF. Both systolic and diastolic dysfunction influence functional capacity.