SUSTAINED LEFT-VENTRICULAR DIASTOLIC DYSFUNCTION AFTER EXERCISE IN PATIENTS WITH DILATED CARDIOMYOPATHY

Objective-To investigate the recovery process of exercise induced dias tolic dysfunction in heart failure, using Doppler echocardiographic te chniques. Design and patients-Transmitral flow velocity profiles and s tandard non-invasive haemodynamic indices were obtained serially over seven days after symptom limited bicycle exercise tests in 18 patients with dilated cardiomyopathy and eight normal subjects. In three patie nts with cardiomyopathy we also measured the pulmonary capillary wedge pressure for 24 hours after exercise. Results-The intensity of exerci se, as assessed by respiratory gas analysis, was lower in patients wit h dilated cardiomyopathy than in normal subjects. Despite the higher e xercise level, all haemodynamic variables returned to baseline within one hour after exercise in normal subjects. In contrast, patients with dilated cardiomyopathy showed a sustained decrease in the peak early diastolic filling velocity and a sustained increase in the deceleratio n time of early filling for 24 hours or more after exercise. Because o ther haemodynamic variables recovered within one hour after exercise e ven in patients with dilated cardiomyopathy, the postexercise changes in ventricular filling were not explained by changes in loading condit ions, Conclusions-Exercise induced diastolic left ventricular dysfunct ion of the failing heart persists for 24 hours or more after exercise. The efficacy of exercise training on a daily basis in dilated cardiom yopathy requires further evaluation.