Copyright © 2001 by the European Society of Cardiology.
Preservation of exercise capacity and lack of peripheral changes in asymptomatic patients with severely impaired left ventricular function
a Cardiology Department, Kent and Sussex Hospital, Tunbridge Wells, Kent, U.K.
b Royal Brompton Hospital and National Heart and Lung Institute, Imperial College of Science, Technology and Medicine, London, U.K.
revised July 10, 2000; accepted July 12, 2000
Abstract
Aims To establish the extent, if any, of peripheral changes in asymptomatic patients with severe left ventricular dysfunction.
Methods and Results Nine asymptomatic and nine symptomatic patients with left ventricular ejection fraction, <25%, matched for age and left ventricular ejection fraction (asymptomatic vs symptomatic, age: 52±1·5 vs 55·9±2·5 years [Mean±SEM], left ventricular ejection fraction: 16±2 vs 19±2%P=0·23 and 0·48, respectively) were studied and compared with 26 age-matched normal controls. We assessed exercise capacity, leg blood flow (occlusion plethysmography), respiratory muscle strength, quadriceps maximal isometric strength, fatigue and CT cross-sectional muscle area at mid thigh. Fatigue was expressed as the percentage reduction in maximal strength following a 20min fatiguing protocol. There was a graded increase in peak oxygen consumption comparing symptomatic, asymptomatic and control groups (16·6±1·3 vs 27·1±1·6 vs 32·8±1·3ml.min–1.kg–1respectively, ANOVA P<0·0001). Between the three groups there was significant variation in muscle strength (P<0·0001), endurance (P=0·0002) and cross-sectional area (P=0·0003) and in peak blood flow (P=0·027) and respiratory muscle strength (P<0·05). When asymptomatic patients and controls were compared no significant differences existed.
Conclusions Patients with severe left ventricular dysfunction may have near normal exercise capacity and no peripheral changes. Exercise capacity may depend less upon left ventricular function than on the presence or absence of peripheral factors.
Key Words: Heart failure, exercise capacity, skeletal muscle
f1 Correspondence: Professor A. J. S. Coats, Department of Cardiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, U.K.
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