Published Online
on March 10, 2003

A more recent version of this article appeared on April 1, 2003

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Submitted on September 5, 2002
Revised on November 7, 2002
Accepted on November 8, 2002

Aortic Distensibility Independently Affects Exercise Tolerance in Patients With Dilated Cardiomyopathy

Stefano Bonapace MD, Andrea Rossi MD^*, Mariantonietta Cicoira MD, Lorenzo Franceschini MD, Giorgio Golia MD, Luisa Zanolla MD, Paolo Marino MD, and Piero Zardini MD

From Dipartimento di Scienze Biomediche e Chirurgiche, Sezione di Cardiologia, Università degli Studi di Verona, Verona, Italy.

^* To whom correspondence should be addressed. E-mail: andrea.rossi{at}univr.it.

Background--Peak exercise oxygen consumption (VO₂) is crucial for the prognostic stratification of patients with congestive heart failure, but its hemodynamic determinants are still not completely understood. Aortic wall elasticity modulates left ventricular function and coronary blood flow. Whether an increased aortic pulse-wave velocity (PWV), a known marker of arterial stiffness, may predict peak VO₂ in patients with dilated cardiomyopathy (DCM) has to be clarified.

Methods and Results--A total of 78 patients with clinical diagnosis of DCM (aged 62±11 years; female 29%; mean ejection fraction 34±9%) were selected. All patients underwent a complete echocardiographic-Doppler evaluation. Aortic PWV was measured by Doppler ultrasonography immediately before the exercise. A bicycle exercise test with expiratory gas exchange monitoring was performed to determine VO₂. Plasma concentration of the amino-terminal propeptide of type III procollagen (PIIINP), a marker of extracellular matrix turnover, was determined. Mean PWV was 5.7±2.2 m/s, and VO₂ was 16.5±4.5 mL · kg^-1 · min^-1. The hemodynamic variables correlated with VO₂ were PWV (r=-0.39, P=0.0007) and stroke volume (r=0.38, P=0.002). In a multivariate analysis, PWV (P=0.04) and stroke volume (P=0.05) were independently correlated with VO₂, accounting for 34% of its variance. PIIINP levels correlated with PWV (r=0.35, P=0.002) and a more restrictive diastolic filling pattern (r=0.40, P=0.02).

Conclusions--Increased aortic stiffness measured by PWV is an independent predictor of peak VO₂ and could partially explain exercise intolerance in patients with DCM.

Key words: heart failure • cardiomyopathy • aorta • exercise

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