[Exercise echocardiography in dilatative cardiomyopathy]

Using M-mode echocardiography under 2-D control at rest and during ergometer exercise (ex), we examined 15 patients (pat) with angiographically moderate diffuse left ventricular (LV) contraction impairment (mean enddiastolic volume index 115 ml/m2, mean ejection fraction 58%) (group DCM I). The aim of the study was to look for differences in LV behavior under exercise within this patient group, with a view to aiding diagnosis. These pat were compared to 10 normal subjects (N) and 10 pat with advanced dilatative (congestive) cardiomyopathy (enddiastolic volume index 135 ml/m2, ejection fraction 44%) (DCM II). Even at rest, the LV diameters and the fractional shortening (FS) in the group DCM I differed significantly from those in N, and in the case of the mean FS the difference increased on ex (rest p less than 0.05, exertion p less than 0.0005). In none of the three groups did the enddiastolic diameter undergo any significant change on ex. The endsystolic diameter decreased in N by an average of 5.2 mm (p less than 0.0005); at 2.8 mm (p less than 0.005), the decrease (DCM I vs N p less than 0.005) was distinctly slighter to be observed in DCM I; in DCM II it was no longer significant. Within the group DCM I, 4 pat showed a behavior on ex that was not what the values at rest would have suggested. 2 pat showed a physiological reaction on ex despite a restricted function at rest; however, in 2 patients with relatively good values at rest, the FS decreased on ex. According to these findings, a restriction of LV function is to be recognized echocardiographically more clearly on ex than at rest, especially in low-level dilatative cardiomyopathy (DCM). In individual cases, a varying increase in LV functional impairment is to be observed during ex, or even generalized physiological reaction, which would not be expected from the echocardiogram at rest. Thus the results of the examination present a differentiated basis for the observation of the course of the disease, especially in pat with a moderate DCM.