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European Heart Journal 1992 13(6):749-757;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Abnormal diastolic filling patterns in chronic heart failure—relationship to exercise capacity

S. W. DAVIES*,, A. L. FUSSELL*, S. L. JORDAN*, P. A. POOLE-WILSON* and D. P. LIPKIN*

*Cardiac Department, The Royal Free Hospital London NW3, U.K.
{dagger}The National Heart and Lung Institute London SW3, U.K.

Correspondence: Dr S. W. Davies, Cardiac Department, The London Chest Hospital, Bonner Road, London E2 9JX, U.K.

Abstract

Abnormal patterns of diastolic ventricular filling are well recognized in chronic heart failure, but their relationship to the severity of heart failure is not known. The present study evaluates the relationship of diastolic filling indices to the severity of heart failure and to exercise capacity. In 40 patients with chronic heart failure secondary to ischaemic left ventricular impairment, exercise capacity was measured as peak oxygen consumption (V02max) by progressive treadmill exercise. Left ventricular function was assessed by M-mode and Doppler echocardiographic indices.

Peak aortic velocity correlated weakly with V02max (R = +0.38, P<0.05). VO2max did not correlate with other systolic indices, including mean aortic acceleration, time to peak velocity, or isovolumic contraction time. V02max correlated with the mitral inflow E/A ratio (R=–0.57, P<0.005) and with the Doppler estimate of isovolumic relaxation time (R= –0.48, P<0.01). Two distinct patterns of diastolic filling were observed: subjects with mild-to-moderate heart failure (N YHA grade II, V02max 15–20 ml. kg–1. min–1) had abnormally low E/A ratios and long isovolumic relaxation times, whereas those with severe heart failure (NYHA grade III-IV, V02max <12 ml. kg–1. min–1) had abnormally high E/A ratios and short isovolumic relaxation times.

Different patterns of abnormal diastolic filling with different degrees of severity of heart failure may explain some of the previous controversy as to the prevalence of abnormal diastolic function in chronic heart failure. Exercise capacity in chronic heart failure appears more closely related to abnormalities of diastolic filling pattern than to indices of systolic function.

Key Words: Diastolic filling • chronic heart failure • peak oxygen consumption • Doppler echocardiography


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