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Heart 1998;80:565-569; doi:10.1136/hrt.80.6.565
Copyright © 1998 BMJ Publishing Group Ltd & British Cardiovascular Society

Heart 1998;80:565-569 ( December )

Echo derived variables predicting exercise tolerance in patients with dilated and poorly functioning left ventricle

K M Webb-Peploe, M Y Henein, A J S Coats, D G Gibson

Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK

Correspondence to: Dr Gibson.

Accepted for publication 17 July 1998

Objective---To determine whether resting echo derived measurements predict exercise tolerance and its interrelation with heart rate response and ventilation drive in patients with systolic left ventricular disease.
Design---Prospective echocardiographic examination followed by cardiopulmonary exercise testing.
Setting---A tertiary referral centre for cardiac diseases.
Subjects---21 patients (11 with coronary artery disease, 10 with idiopathic dilated cardiomyopathy) with end diastolic dimension > 6.4 cm, shortening fraction< 25%, and in sinus rhythm. There were 11 age matched normal controls.
Results---In the patients, peak oxygen consumption (mVO2) correlated with right ventricular long axis excursion (r = 0.62); 65% of the variance in mVO2 was predictable using a multivariate model with right ventricular long axis excursion and peak lengthening rate, and peak mitral atrial filling velocity as independent variables. Aetiology was not an independent predictor, although the right ventricular long axis excursion (mean (SD)) was greater in patients with idiopathic dilated cardiomyopathy than in those with coronary artery disease (2.4 (0.5) cm v 1.6 (0.5) cm, p < 0.001). Peak heart rate correlated with duration of mitral regurgitation (r = -0.52) and the slope of ventilation against CO2 production correlated with M mode isovolumic relaxation time (r = 0.61).
Conclusions---In patients with systolic left ventricular dysfunction, more than half the variance in exercise tolerance can be predicted by factors measured on echocardiography at rest, particularly right ventricular long axis excursion.

Keywords: left ventricular function;  heart failure;  exercise tolerance;  echocardiography

© 1998 by Heart
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