Relation of “inotropic reserve” to functional capacity in heart failure secondary to ischemic or nonischemic cardiomyopathy
Section snippets
Study patients:
We conducted a retrospective study examining a consecutive series of 35 patients with a dilated cardiomyopathy having an LV end-diastolic dimension >6.0 cm and an LVEF <50%. These patients were clinically stable and receiving optimized medical management of their heart failure. A summary of patient characteristics and their medical therapy is shown in Table 1. This retrospective review was approved by the University of Wisconsin Human Subjects Committee.
Exercise testing:
Exercise tests were performed to evaluate
Resting echocardiographic data (Table 2):
At rest LV systolic function was severely depressed, LV size markedly increased, and the regional wall motion index significantly depressed. RV function was only mildly impaired. There were heterogenous abnormalities of LV filling. Although the mean E/A ratio was increased and the mean deceleration time relatively decreased, only 50% of the study group had an E/A ratio >2.0, and only 43% a deceleration time <130 ms. Several patients (35%) had an E/A ratio <1.0, and a small group (14%) had a
Discussion
The major finding of this study is that peak VO2 is significantly related to both LV inotropic reserve and RV function. For the right ventricle, the strongest factor was resting systolic function, evident in the group with higher functional capacity having either normal or only mildly reduced RV function, whereas RV function in the group with lower functional capacity was typically mildly or moderately reduced. These findings are consistent with previous studies that have calculated
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