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Original Contribution
January 21, 2009

Left Ventricular Function and Exercise Capacity

Author Affiliations

Author Affiliations: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.

JAMA. 2009;301(3):286-294. doi:10.1001/jama.2008.1022

Context Limited information exists regarding the role of left ventricular function in predicting exercise capacity and impact on age- and sex-related differences.

Objectives To determine the impact of measures of cardiac function assessed by echocardiography on exercise capacity and to determine if these associations are modified by sex or advancing age.

Design Cross-sectional study of patients undergoing exercise echocardiography with routine measurements of left ventricular systolic and diastolic function by 2-dimensional and Doppler techniques. Analyses were conducted to determine the strongest correlates of exercise capacity and the age and sex interactions of these variables with exercise capacity.

Setting Large tertiary referral center in Rochester, Minnesota, in 2006.

Participants Patients undergoing exercise echocardiography using the Bruce protocol (N = 2867). Patients with echocardiographic evidence of exercise-induced ischemia, ejection fractions lower than 50%, or significant valvular heart disease were excluded.

Main Outcome Measure Exercise capacity in metabolic equivalents (METs).

Results Diastolic dysfunction was strongly and inversely associated with exercise capacity. Compared with normal function, after multivariate adjustment, those with moderate/severe resting diastolic dysfunction (−1.30 METs; 95% confidence interval [CI], −1.52 to −0.99; P < .001) and mild resting diastolic dysfunction (−0.70 METs; 95% CI, −0.88 to −0.46; P < .001) had substantially lower exercise capacity. Variation of left ventricular systolic function within the normal range was not associated with exercise capacity. Left ventricular filling pressures measured by resting E/e′ of 15 or greater (−0.41 METs; 95% CI, −0.70 to −0.11; P = .007) or postexercise E/e′ of 15 or greater (−0.41 METs; 95% CI, −0.71 to −0.11; P = .007) were similarly associated with a reduction in exercise capacity, each in separate multivariate analyses. Individuals with impaired relaxation (mild dysfunction) or resting E/e′ of 15 or greater had a progressive increase in the magnitude of reduction in exercise capacity with advancing age (P < .001 and P = .02, respectively). Other independent correlates of exercise capacity were age (unstandardized β coefficient, −0.85 METs; 95% CI, −0.92 to −0.77, per 10-year increment; P < .001), female sex (−1.98 METs; 95% CI, −2.15 to −1.84; P < .001), and body mass index greater than 30 (−1.24 METs; 95% CI, −1.41 to −1.10; P < .001).

Conclusion In this large cross-sectional study of those referred for exercise echocardiography and not limited by ischemia, abnormalities of left ventricular diastolic function were independently associated with exercise capacity.