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Relation of changes over time in ventricular size and function to those in exercise capacity in patients with chronic
V G Florea1, M Y Henein, S D Anker
1Department of Cardiac Medicine, National Heart and Lung Institute, London, United Kingdom. vioflor@hotmail.com
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Changes in left ventricular (LV) size and mass correlate with exercise capacity in chronic heart failure (CHF) patients. These findings highlight the link between cardiac structure changes and functional outcomes in CHF.
Area of Science:
- Cardiology
- Exercise Physiology
- Heart Failure Research
Background:
- Chronic heart failure (CHF) is characterized by progressive cardiac dysfunction.
- Left ventricular (LV) remodeling, including changes in cavity size and mass, is a hallmark of CHF.
- The relationship between LV structural changes and exercise capacity in CHF requires further elucidation.
Purpose of the Study:
- To investigate the longitudinal changes in left ventricular (LV) cavity dimensions and mass in patients with chronic heart failure (CHF).
- To determine the relationship between these changes in LV structure and alterations in exercise performance and respiratory efficiency.
Main Methods:
- Longitudinal study involving 59 patients with CHF and enlarged LV end-diastolic diameter (EDD >55 mm).
- Echocardiography and treadmill cardiopulmonary exercise testing were performed at baseline and after a median of 14 months.
- Statistical analysis to correlate changes in LV dimensions (EDD, ESD) and mass with changes in peak oxygen consumption (Vo2) and ventilatory response.
Main Results:
- Left ventricular end-diastolic diameter (EDD) increased in 63% and decreased in 37% of patients.
- Significant correlations were found between annual changes in LV dimensions/mass and changes in peak Vo2 (r = -0.44 to -0.56, P <.001).
- Changes in LV dimensions/mass were also strongly related to ventilatory response to exercise (r = 0.60 to 0.72, P <.001).
Conclusions:
- Longitudinal changes in left ventricular (LV) dimensions and mass are significantly associated with exercise capacity in patients with chronic heart failure (CHF).
- Objective measures of LV remodeling correlate with functional status and respiratory efficiency in CHF.
- These findings underscore the importance of monitoring cardiac structure for predicting exercise performance in CHF management.
Background:
We studied the direction and magnitude of changes in left ventricular (LV) cavity size and mass over time and whether these changes were related to those in exercise performance in patients with chronic heart failure (CHF).
Methods And Results:
The study group was composed of 59 patients (55 men aged 58 +/- 10 years) with CHF and LV end-diastolic diameter (EDD) >55 mm. All underwent echocardiography and a treadmill cardiopulmonary exercise test within a 4-week interval (baseline) and again after a period of >/=4 months (median of 14 months). At baseline, the group as a whole had moderate to severe LV dysfunction with an EDD of 70 +/- 9 mm, end-systolic diameter (ESD) of 60 +/- 11 mm, and LV mass of 500 +/- 200 g. The mean peak oxygen consumption (Vo (2), 18 +/- 6 mL/kg per minute) was unrelated to LV cavity size or mass. EDD increased in 37 (63%) of the patients and fell in 22 (37%) patients from the initial to the second test. The absolute magnitude of changes over time averaged 7 mm for EDD, 125 g for mass, and 6 mL/kg per minute for peak Vo(2). Changes in LV size and mass per year were significantly related to those in peak Vo(2) (r = -0.49 for EDD, r = -0.56 for ESD, and r = -0.44 for LV mass, respectively, all P <.001) and ventilatory response to exercise (r = 0.60, r = 0.58, and r = 0.72 for EDD, ESD, and LV mass; respectively, all P <.001).
Conclusions:
Changes over time in objective measures of LV dimensions and mass, in patients with CHF are significantly related to those in exercise capacity and respiratory efficiency.