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J Appl Physiol (June 18, 2004). doi:10.1152/japplphysiol.00078.2004
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Submitted on January 22, 2004
Accepted on June 14, 2004

Left Ventricular Chamber Stiffness at Rest as a Determinant of Exercise Capacity in Heart Failure Subjects with Decreased Ejection Fraction

Timothy E Meyer1, Mustafa Karamanoglu1, Ali A Ehsani2, and Sandor J Kovacs1*

1 Cardiovascular Biophysics Laboratory, Washington University School of Medicine, St. Louis, MO, USA
2 Section of Applied Physiology, Washington University School of Medicine, St. Louis, MO, USA

* To whom correspondence should be addressed. E-mail: sjk{at}wuphys.wustl.edu.

Impaired exercise tolerance, determined by peak oxygen consumption (VO2peak), 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 VO2peak are known correlates of HF. Yet, the relationship between chamber stiffness and VO2peak in subjects with HF has not been fully determined. Forty-one patients with HF (NYHA class 2.4±0.8, mean±SD) had echocardiographic studies and VO2peak 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 VO2peak 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 VO2peak. We conclude that diastolic function at rest, as manifested by chamber stiffness, is a major determinant of maximal exercise capacity in HF.




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