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Relation between left ventricular shape and exercise capacity in patients with left ventricular dysfunction

M D Tischler1, J Niggel, D T Borowski

  • 1Cardiology Unit, Medical Center Hospital of Vermont, Burlington 05401.

Journal of the American College of Cardiology
|September 1, 1993
PubMed
Summary
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Dynamic changes in heart shape, specifically sphericity index, strongly predict exercise duration in patients with systolic left ventricular dysfunction, outperforming traditional measures. This finding highlights the importance of dynamic cardiac geometry for assessing exercise capacity.

Area of Science:

  • Cardiology
  • Echocardiography
  • Exercise Physiology

Background:

  • Resting left ventricular volumes and ejection fraction are insufficient predictors of exercise capacity in systolic left ventricular dysfunction.
  • Previous studies suggested resting left ventricular shape influences exercise duration, but dynamic changes during exercise were uninvestigated.

Purpose of the Study:

  • To identify dynamic predictors of exercise duration in patients with systolic left ventricular dysfunction.
  • To determine if left ventricular shape changes during exercise independently predict exercise duration.

Main Methods:

  • Twenty-one patients with ejection fraction < 40% underwent symptom-limited graded exercise testing with 2D echocardiography.
  • Measurements included end-diastolic volume, end-systolic volume, stroke volume, ejection fraction, and sphericity index at rest and peak exercise.

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Main Results:

  • Exercise duration averaged 8.9 min for 11 patients and 4.9 min for 10 patients.
  • No patient experienced exercise-induced ischemia.
  • Peak exercise end-systolic and end-diastolic sphericity indexes, and the change in end-systolic sphericity index during exercise, strongly correlated with exercise duration (r=0.809, 0.711, and 0.697, respectively).

Conclusions:

  • Standard measures of left ventricular function poorly predict exercise capacity in this patient group.
  • Dynamic alterations in left ventricular shape, particularly sphericity, are strong determinants of exercise duration.
  • Assessing dynamic cardiac geometry may improve the evaluation of exercise capacity in systolic left ventricular dysfunction.