title: Determinants of functional capacity in patients with chronic heart failure: role of filling pressure and systolic and diastolic function.
abstract: BACKGROUND
  Previous work suggesting a better correlation of diastolic than systolic function with exercise capacity in heart failure may reflect the relative insensitivity and load-dependence of ejection fraction (EF). We sought the correlation of new and more sensitive methods of quantifying systolic and diastolic function and filling pressure with functional capacity.
  
  
  METHODS
  We studied 155 consecutive exercise tests on 95 patients with congestive heart failure (81 male, aged 62 +/- 10 years), who underwent resting 2-dimensional echocardiography and tissue Doppler imaging before and after measurement of maximum oxygen uptake (peak VO2).
  
  
  RESULTS
  The resting EF was 31% +/- 10% and a peak VO2 was 13 +/- 5 mL/kg.min; the majority of these patients (80%) had an ischemic cardiomyopathy. Resting EF (r = 0.14, P = .09) correlated poorly with peak VO2 and mean systolic (r = 0.23, P = .004) and diastolic tissue velocities (r = 0.18, P = .02). Peak EF was weakly correlated with the mean systolic (r = 0.18, P = .02) and diastolic velocities (r = 0.16, P < .04). The mean sum of systolic and diastolic velocities in both annuli (r = 0.30, P < .001) and E/Ea ratio (r = -0.31, P < .001) were better correlated with peak VO2 . Prediction of peak VO2 was similar with models based on models of filling pressure (R = 0.61), systolic factors (R = 0.63), and diastolic factors (R = 0.59), although a composite model of filling pressure, systolic and diastolic function was a superior predictor of peak VO2 (R = 0.69; all P < .001).
  
  
  CONCLUSIONS
  The reported association of diastolic rather than systolic function with functional capacity may have reflected the limitations of EF. Functional capacity appears related not only to diastolic function, but also to systolic function and filling pressure, and is most closely associated with a combination of these factors.
authors.affiliation: Department of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Smart
authors.forename: Brian
authors.initials: B
authors.lastname: Haluska
authors.forename: Rodel
authors.initials: R
authors.lastname: Leano
authors.forename: Colin
authors.initials: C
authors.lastname: Case
authors.forename: Philip M
authors.initials: PM
authors.lastname: Mottram
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002908:Chronic Disease; D003327:Coronary Disease / Q000150:complications; D015150:Echocardiography, Doppler / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D010101:Oxygen Consumption; D011379:Prognosis; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016276:Ventricular Function