Document Detail

Left ventricular function and exercise capacity.
MedLine Citation:
PMID:  19155455     Owner:  NLM     Status:  MEDLINE    
CONTEXT: Limited information exists regarding the role of left ventricular function in predicting exercise capacity and impact on age- and sex-related differences.
OBJECTIVES: To determine the impact of measures of cardiac function assessed by echocardiography on exercise capacity and to determine if these associations are modified by sex or advancing age.
DESIGN: Cross-sectional study of patients undergoing exercise echocardiography with routine measurements of left ventricular systolic and diastolic function by 2-dimensional and Doppler techniques. Analyses were conducted to determine the strongest correlates of exercise capacity and the age and sex interactions of these variables with exercise capacity.
SETTING: Large tertiary referral center in Rochester, Minnesota, in 2006.
PARTICIPANTS: Patients undergoing exercise echocardiography using the Bruce protocol (N = 2867). Patients with echocardiographic evidence of exercise-induced ischemia, ejection fractions lower than 50%, or significant valvular heart disease were excluded.
MAIN OUTCOME MEASURE: Exercise capacity in metabolic equivalents (METs).
RESULTS: Diastolic dysfunction was strongly and inversely associated with exercise capacity. Compared with normal function, after multivariate adjustment, those with moderate/severe resting diastolic dysfunction (-1.30 METs; 95% confidence interval [CI], -1.52 to -0.99; P < .001) and mild resting diastolic dysfunction (-0.70 METs; 95% CI, -0.88 to -0.46; P < .001) had substantially lower exercise capacity. Variation of left ventricular systolic function within the normal range was not associated with exercise capacity. Left ventricular filling pressures measured by resting E/e' of 15 or greater (-0.41 METs; 95% CI, -0.70 to -0.11; P = .007) or postexercise E/e' of 15 or greater (-0.41 METs; 95% CI, -0.71 to -0.11; P = .007) were similarly associated with a reduction in exercise capacity, each in separate multivariate analyses. Individuals with impaired relaxation (mild dysfunction) or resting E/e' of 15 or greater had a progressive increase in the magnitude of reduction in exercise capacity with advancing age (P < .001 and P = .02, respectively). Other independent correlates of exercise capacity were age (unstandardized beta coefficient, -0.85 METs; 95% CI, -0.92 to -0.77, per 10-year increment; P < .001), female sex (-1.98 METs; 95% CI, -2.15 to -1.84; P < .001), and body mass index greater than 30 (-1.24 METs; 95% CI, -1.41 to -1.10; P < .001).
CONCLUSION: In this large cross-sectional study of those referred for exercise echocardiography and not limited by ischemia, abnormalities of left ventricular diastolic function were independently associated with exercise capacity.
Jasmine Grewal; Robert B McCully; Garvan C Kane; Carolyn Lam; Patricia A Pellikka
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  JAMA     Volume:  301     ISSN:  1538-3598     ISO Abbreviation:  JAMA     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-21     Completed Date:  2009-01-23     Revised Date:  2014-09-24    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  United States    
Other Details:
Languages:  eng     Pagination:  286-94     Citation Subset:  AIM; IM    
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MeSH Terms
Blood Pressure
Cross-Sectional Studies
Echocardiography, Doppler
Echocardiography, Stress*
Exercise Test
Exercise Tolerance*
Heart Rate
Middle Aged
Ventricular Function, Left*
Grant Support
Comment In:
JAMA. 2009 Jun 10;301(22):2326; author reply 2326-7   [PMID:  19509377 ]
JAMA. 2009 Jun 10;301(22):2325-6; author reply 2326-7   [PMID:  19509376 ]

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