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1 Department of Cardiology, Barnes Jewish Hospital, St. Louis, Missouri, USA
2 Department of Cardiovascular Imaging, Cleveland Clinic Foundation, Cleveland, Ohio, USA
* To whom correspondence should be addressed. E-mail: greenbn{at}ccf.org.
Objectives: We sought to elucidate the relationship between diastolic intraventricular pressure gradients (IVPG) and exercise tolerance in patients with heart failure using color M-mode Doppler. Background: Diastolic dysfunction has been implicated as a cause of low aerobic potential in patients with heart failure. We have previously validated a novel method to evaluate diastolic function that involves non-invasive measurement of IVPG utilizing color M-mode Doppler data. Methods: Thirty-one patients with heart failure and 15 normal subjects were recruited. Echocardiograms were performed before and after metabolic treadmill stress testing. Color M-mode Doppler was used to determine the diastolic propagation velocity (Vp) and IVPG off-line. Results: Resting diastolic function indices including myocardial relaxation velocity (Ea), Vp, and E/Vp correlated well with VO2 max: (r = 0.8, 0.5, and -0.5, respectively, P<0.001 for all). There was a statistically significant increase in Vp and IVPG in both groups after exercise, but the change in IVPG was higher in normal subjects compared to patients with heart failure (2.6 ± 0.8 versus 1.1 ± 0.8 mmHg, P<0.05). Increase in IVPG correlated with peak VO2 max (r = 0.8, P<0.001), and was the strongest predictor of exercise capacity. Conclusions: Myocardial relaxation is an important determinant of exercise aerobic capacity. In heart failure patients, impaired myocardial relaxation is associated with reduced diastolic suction force during exercise.
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