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 (mV˙o ₂) correlated with right ventricular long axis excursion (r = 0.62); 65% of the variance in mV˙o ₂ 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 co ₂ 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.