Clinical assessment and follow-up of functional capacity in patients with chronic congestive cardiomyopathy |
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Authors: | Robert Engler MD Richard Ray MD Charles B. Higgins MD FACC Catherine McNally RN Wendy Hansen Buxton RN Valmik Bhargava PhD Ralph Shabetai MD FACC |
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Affiliation: | a From the Veterans Administration Hospital Research Service, San Diego, California, USA b From the Department of Medicine, Cardiology Section, University of California, San Diego School of Medicine, La Jolla, California, USA |
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Abstract: | The presumption that the results of left ventricular systolic function tests performed at rest are related to the symptoms of chronic congestive heart failure or to exercise capacity is unproved. Thirty-three patients with chronic congestive Cardiomyopathy underwent serial exercise tests, determinations of ejection fraction and systolic time intervals, echocardiograms, assessment of symptom score, chest roentgenogram, and physical examination over a mean (± standard deviation) of 24.8 ± 14.1 months. Maximal exercise performance achieved correlation with symptoms (r = −0.66) but not with indexes of left ventricular function. Edema, elevated jugular venous pressure, rales and radiologic evidence of pulmonary venous hypertension were more common in patients with severe limitation of exercise capacity. In 17 patients whose functional capacity changed during the follow-up period, congruent changes in left ventricular function measured at rest were not consistently observed. Thus the findings on history, physical examination and radiologic examination correlate with exercise capacity, but indexes of left ventricular performance at rest do not and therefore are of limited use in assessing treatment. The clinical course of patients with chronic congestive cardiomyopathy can be followed up safely, effectively and economically by simple clinical observations. Serial laboratory testing of left ventricular function can be reserved for specific indications, research and patients with valvular heart disease. |
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Keywords: | Address for reprints: Robert Engler MD Director Intensive Care Units Veterans Administration Medical Center (111-A) San Diego California 92161. |
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