SYSTOLIC AND DIASTOLIC FUNCTION IN PATIENTS WITH CHRONIC HEART-FAILURE AT REST AND DURING EXERCISE

In our study we tried to evaluate systolic and diastolic function in p atients with chronic heart failure (CHF) by using some echocardiograph ic parameters and invasively measured pulmonary capillary wedge pressu re (PCWP). We studied 19 patients with CHF NYHA II-III at rest, at the end of isometric exercise (handgrip) and during a bicycle stress test . Right heart catheterization and echocardiography were simultaneously performed. We measured exchange of blood gases, end diastolic volume (EDV), end systolic volume (ESV), ejection fraction (EF), peak E veloc ity, peak A velocity, E/A ratio, deceleration time of E wave (DT), tim e of mitral regurgitation (MR) and effective filling period of left ve ntricle (FP). We divided patients according to the median of PCWP at r est into two groups: group A with PCWP less than or equal to 11 mmHg ( 10 pts), group B with PCWP>11 mmHg (9 pts). In group A mean PCWP at re st was 6+/-2 mmHg, during handgrip 12+/-4 mmHg and during bicycle exer cise 18+/-6 mmHg. In group B mean values of PCWP were 19+/-6 mmHg, 26/-11 mmHg and 33+/-5 mmHg, respectively. All values were significantly higher in group B (P<0.01). There was a significant difference in pVO 2: in group A 18.8+/-3.5 vs. 14.7+/-3.3 ml/kg per min in group B (P<0. 03). No differences between the groups were noticed in EDV, ESV and EF . The E/A ratio in group A was less than 1, in group B greater than 1 with the restrictive pattern. No differences between the groups were o bserved in MR and FP at rest. During bicycle exercise, MR was signific antly longer (284+/-98 vs. 164+/-79 ms; P<0.05) and FP shorter (322+/- 99 vs. 421+/-74 ms; P<0.05) in group B than in group A. The functional capacity of patients with CHF is influenced not only by EF and other systolic variables, but also by filling conditions. The duration of ef fective diastole may be one of the most important of them. (C) 1997 El sevier Science Ireland Ltd.