Maximal Exercise Tolerance in Chronic Congestive Heart Failure

Relationship to Resting Left Ventricular Function

¹ From the Division of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh

The relationship between maximal exercise tolerance and resting radionuclide indexes of left ventricular systolic and diastolic function were evaluated in 20 ischemic and 44 idiopathic cardiomyopathy patients with New York Heart Association class 2-4 chronic congestive heart failure. Left ventricular ejection fraction, peak systolic ejection rate, peak diastolic filling rate, time to peak filling from end-systolic volume, and fractional filling in early diastole were measured from the radionuclide ventriculogram. All patients underwent symptom-limited exercise testing with on-line measurement of oxygen consumption. In the ischemic group, all of the radionuclide indexes correlated poorly with maximal exercise oxygen consumption (VO₂max) except the peak systolic ejection rate which correlated modestly (r=0.58, p<0.05). Peak systolic ejection rate was significantly lower (p<0.01) as were the peak diastolic filling rate and fractional filling in the first third of diastole (p<0.05) in ischemic patients with marked exercise intolerance (Vo₂max14 mL/kg/min) compared with those with preserved exercise tolerance (Vo₂max > 14 mL/kg/min). In the idiopathic group, none of the radionuclide indexes correlated well with Vo₂max; and all indexes were similar in patients with and without marked exercise intolerance. These data suggest that (1) resting left ventricular ejection fraction poorly predicts maximal exercise capacity in both ischemic and idiopathic cardiomyopathy and (2) resting peak systolic ejection rate, peak diastolic filling rate, and fractional filling in early diastole may predict exercise tolerance in ischemic but not idiopathic cardiomyopathy.

Key Words: congestive heart failure • exercise tolerance • left ventricular diastolic function • left ventricular systolic function

Submitted on January 19, 1993
Accepted on February 14, 1994

This article has been cited by other articles:

				M. L. Alkotob, P. Soltani, M. A. Sheatt, M. C. Katsetos, N. Rothfield, W. D. Hager, R. J. Foley, and D. I. Silverman Reduced exercise capacity and stress-induced pulmonary hypertension in patients with scleroderma. Chest, July 1, 2006; 130(1): 176 - 181. [Abstract] [Full Text] [PDF]

				K K A Witte, N P Nikitin, R De Silva, J G F Cleland, and A L Clark Exercise capacity and cardiac function assessed by tissue Doppler imaging in chronic heart failure Heart, October 1, 2004; 90(10): 1144 - 1150. [Abstract] [Full Text] [PDF]

				G. V. Guimaraes, G. Bellotti, A. O. Mocelin, P. R. Camargo, and E. A. Bocchi Cardiopulmonary Exercise Testing in Children With Heart Failure Secondary to Idiopathic Dilated Cardiomyopathy Chest, September 1, 2001; 120(3): 816 - 824. [Abstract] [Full Text] [PDF]

				D Scrutinio, V Napoli, A Passantino, A Ricci, R Lagioia, and P Rizzon Low-dose dobutamine responsiveness in idiopathic dilated cardiomyopathy: relation to exercise capacity and clinical outcome Eur. Heart J., June 1, 2000; 21(11): 927 - 934. [Abstract] [PDF]