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J Appl Physiol 97: 1667-1672, 2004. First published June 18, 2004; doi:10.1152/japplphysiol.00078.2004
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Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction

Timothy E. Meyer,1 Mustafa Karamanoglu,1 Ali A. Ehsani,2 and Sándor J. Kovács1

1Cardiovascular Biophysics Laboratory and 2Section of Applied Physiology, Washington University School of Medicine, St. Louis, Missouri 63110

Submitted 22 January 2004 ; accepted in final form 14 June 2004

Impaired exercise tolerance, determined by peak oxygen consumption (O2 peak), is predictive of mortality and the necessity for cardiac transplantation in patients with chronic heart failure (HF). However, the role of left ventricular (LV) diastolic function at rest, reflected by chamber stiffness assessed echocardiographically, as a determinant of exercise tolerance is unknown. Increased LV chamber stiffness and limitation of O2 peak are known correlates of HF. Yet, the relationship between chamber stiffness and O2 peak in subjects with HF has not been fully determined. Forty-one patients with HF New York Heart Association [(NYHA) class 2.4 ± 0.8, mean ± SD] had echocardiographic studies and O2 peak measurements. Transmitral Doppler E waves were analyzed using a previously validated method to determine k, the LV chamber stiffness parameter. Multiple linear regression analysis of O2 peak variance indicated that LV chamber stiffness k (r2 = 0.55) and NYHA classification (r2 = 0.43) were its best independent predictors and when taken together account for 59% of the variability in O2 peak. We conclude that diastolic function at rest, as manifested by chamber stiffness, is a major determinant of maximal exercise capacity in HF.

diastole; echocardiography; oxygen consumption


Address for reprint requests and other correspondence: S. J. Kovács, Cardiovascular Biophysics Laboratory, Washington University School of Medicine, 660 South Euclid Ave., Box 8086, St. Louis, MO 63110 (E-mail: sjk{at}wuphys.wustl.edu).




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