EVALUATION OF LEFT-VENTRICULAR DIASTOLIC DYSFUNCTION USING EXERCISE DOPPLER-ECHOCARDIOGRAPHY - CLINICAL APPROACH IN PATIENTS WITH CONGESTIVE-HEART-FAILURE

In 58 patients (mean age: 43 SD 12 years) presenting with mild to adva nced grade congestive heart failure (NYHA I-III) and 10 volunteers (co ntrol group) (mean age: 29 SD 6 years) two-dimensional and Doppler ech ocardiography was performed at rest, during and 6 min after submaximal bicycle ergometric exercise. The left ventricular systolic function w as estimated by the ejection fraction whereas the left ventricular dia stolic function was evaluated by the ratio of early diastolic and atri al peak-flow velocity (VE/VA) of the mitral inflow. 12 patients were s hown to have a VE/VA-ratio > 1 at rest and during exercise (group 1). In 6 of them (group 1a) the enddiastolic left ventricular diameter was found to be more than 60 mm. In 11 other patients VE/VA-ratio ratio w as proven to be less-than-or-equal-to 1 during exercise only (group 2) . 35 patients exhibited a disturbed diastolic function (VE/VA-ratio le ss-than-or-equal-to 1) at rest (group 3). The volunteers presented a V E/VA-ratio > 1 at rest and during exercise. Left ventricular ejection fraction at rest (%) (xBAR +/- SD) was found to be lower in group 1a t han in all other groups (group 1: 48.6 SD 8.2; group la: 34.3 SD 7.9; group 2: 50.2 SD 8.9; group 3: 45.9 SD 9.9, control group: 53.9 SD 6.9 ; group 1a vs. group 1: p < 0.01; group 1a vs. group 2: p < 0.01; grou p 1a vs. group 3: p < 0.01; group 1a vs. control group: p < 0.01). Pat ients presenting with heart failure and normal ejection fraction were shown to have a mitral flow pattern suggesting a diastolic dysfunction . Since this occurred either during exercise only or at rest yet, hear t failure seemed to be of very mild or moderate grade.