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. 2000 May;83(5):511–517. doi: 10.1136/heart.83.5.511

Abnormal cardiopulmonary exercise variables in asymptomatic relatives of patients with dilated cardiomyopathy who have left ventricular enlargement

N Mahon 1, S Sharma 1, P Elliott 1, M Baig 1, M Norman 1, S Barbeyto 1, W McKenna 1
PMCID: PMC1760817  PMID: 10768898

Abstract

BACKGROUND—Left ventricular enlargement with normal systolic function is common in asymptomatic relatives of patients with familial dilated cardiomyopathy, many of whom progress to overt dilated cardiomyopathy at follow up.
OBJECTIVE—To examine maximal and submaximal gas exchange variables of cardiopulmonary exercise testing in asymptomatic relatives with left ventricular enlargement.
DESIGN AND SETTING—Controlled evaluation of metabolic exercise performance of patients with dilated cardiomyopathy and asymptomatic relatives with left ventricular enlargement identified through prospective family screening in a cardiomyopathy outpatient clinic.
METHODS—23 relatives with left ventricular enlargement, 33 normal controls, 29 patients with dilated cardiomyopathy, and 10 elite athletes with echocardiographic criteria of left ventricular enlargement ("physiological" enlargement) underwent symptom limited upright cycle ergometry using a ramp protocol.
RESULTS—Peak oxygen consumption (p<OVL>V</OVL>O2; mean (SD)) was significantly reduced in relatives with left ventricular enlargement (78 (16.3)%) v normal controls (96%, p < 0.01) and athletes (152%, p < 0.001), but was higher than in patients with dilated cardiomyopathy (69%, p < 0.01). p<OVL>V</OVL>O2 was less than 80% of predicted in 75% of patients, 58% of relatives, 22% of controls, and none of the athletes. Oxygen pulse (p<OVL>V</OVL>O2/heart rate) was less than 80% of predicted in 69% of patients, 35% of relatives, 6% of controls, and none of the athletes. The slope of minute ventilation v CO2 production (ΔVE/Δ<OVL>V</OVL>CO2) was > 30 in 68% of patients, 50% of relatives, and in none of the controls or athletes. Anaerobic threshold, occurring in relatives at 37 (14)% of the predicted <OVL>V</OVL>O2, was higher than in the patients (32%, p < 0.01) and lower than in the controls (45%, p < 0.05) or in the athletes (55%, p < 0.001).
CONCLUSIONS—Maximal and submaximal cardiopulmonary exercise test variables are abnormal in asymptomatic relatives with left ventricular enlargement, in spite of normal systolic function. This provides further evidence that left ventricular enlargement represents subclinical disease in relatives of patients with dilated cardiomyopathy. Metabolic exercise testing can complement echocardiography in identifying relatives at risk for the development of dilated cardiomyopathy.


Keywords: cardiomyopathy; exercise; diagnosis

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Figure 1  .

Figure 1  

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Boxplot of oxygen pulse values for each group, showing median, quartiles, and 95th centiles. Dashed line represents 80% of predicted oxygen pulse.

Figure 2  .

Figure 2  

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Boxplot of p <OVL>V</OVL>O2 per cent predicted for each group, showing median, quartiles, and 95th centiles. Dashed line represents 80% of predicted p<OVL>V</OVL>O2.

Figure 3  .

Figure 3  

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Boxplot of ΔVE/Δ<OVL>V</OVL>CO2 slope for each group, showing median, quartiles, and 95th centiles. Dashed line represents the normal slope of 30. 

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Al-Rawas O. A., Carter R., Richens D., Stevenson R. D., Naik S. K., Tweddel A., Wheatley D. J. Ventilatory and gas exchange abnormalities on exercise in chronic heart failure. Eur Respir J. 1995 Dec;8(12):2022–2028. doi: 10.1183/09031936.95.08122022. [DOI] [PubMed] [Google Scholar]
  2. Astrand I., Astrand P. O., Hallbäck I., Kilbom A. Reduction in maximal oxygen uptake with age. J Appl Physiol. 1973 Nov;35(5):649–654. doi: 10.1152/jappl.1973.35.5.649. [DOI] [PubMed] [Google Scholar]
  3. Baig M. K., Goldman J. H., Caforio A. L., Coonar A. S., Keeling P. J., McKenna W. J. Familial dilated cardiomyopathy: cardiac abnormalities are common in asymptomatic relatives and may represent early disease. J Am Coll Cardiol. 1998 Jan;31(1):195–201. doi: 10.1016/s0735-1097(97)00433-6. [DOI] [PubMed] [Google Scholar]
  4. Banning A. P., Lewis N. P., Northridge D. B., Elborn J. S., Hendersen A. H. Perfusion/ventilation mismatch during exercise in chronic heart failure: an investigation of circulatory determinants. Br Heart J. 1995 Jul;74(1):27–33. doi: 10.1136/hrt.74.1.27. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Beaver W. L., Wasserman K., Whipp B. J. A new method for detecting anaerobic threshold by gas exchange. J Appl Physiol (1985) 1986 Jun;60(6):2020–2027. doi: 10.1152/jappl.1986.60.6.2020. [DOI] [PubMed] [Google Scholar]
  6. Bruce R. A., Kusumi F., Hosmer D. Maximal oxygen intake and nomographic assessment of functional aerobic impairment in cardiovascular disease. Am Heart J. 1973 Apr;85(4):546–562. doi: 10.1016/0002-8703(73)90502-4. [DOI] [PubMed] [Google Scholar]
  7. Chua T. P., Clark A. L., Amadi A. A., Coats A. J. Relation between chemosensitivity and the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol. 1996 Mar 1;27(3):650–657. doi: 10.1016/0735-1097(95)00523-4. [DOI] [PubMed] [Google Scholar]
  8. Chua T. P., Coats A. J. The lungs in chronic heart failure. Eur Heart J. 1995 Jul;16(7):882–887. doi: 10.1093/oxfordjournals.eurheartj.a061019. [DOI] [PubMed] [Google Scholar]
  9. Chua T. P., Ponikowski P., Harrington D., Anker S. D., Webb-Peploe K., Clark A. L., Poole-Wilson P. A., Coats A. J. Clinical correlates and prognostic significance of the ventilatory response to exercise in chronic heart failure. J Am Coll Cardiol. 1997 Jun;29(7):1585–1590. doi: 10.1016/s0735-1097(97)00078-8. [DOI] [PubMed] [Google Scholar]
  10. Cooper D. M., Weiler-Ravell D., Whipp B. J., Wasserman K. Aerobic parameters of exercise as a function of body size during growth in children. J Appl Physiol Respir Environ Exerc Physiol. 1984 Mar;56(3):628–634. doi: 10.1152/jappl.1984.56.3.628. [DOI] [PubMed] [Google Scholar]
  11. Diaz R. A., Obasohan A., Oakley C. M. Prediction of outcome in dilated cardiomyopathy. Br Heart J. 1987 Oct;58(4):393–399. doi: 10.1136/hrt.58.4.393. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hambrecht R., Niebauer J., Fiehn E., Kälberer B., Offner B., Hauer K., Riede U., Schlierf G., Kübler W., Schuler G. Physical training in patients with stable chronic heart failure: effects on cardiorespiratory fitness and ultrastructural abnormalities of leg muscles. J Am Coll Cardiol. 1995 May;25(6):1239–1249. doi: 10.1016/0735-1097(94)00568-B. [DOI] [PubMed] [Google Scholar]
  13. Hansen J. E., Sue D. Y., Wasserman K. Predicted values for clinical exercise testing. Am Rev Respir Dis. 1984 Feb;129(2 Pt 2):S49–S55. doi: 10.1164/arrd.1984.129.2P2.S49. [DOI] [PubMed] [Google Scholar]
  14. Harrington D., Coats A. J. Mechanisms of exercise intolerance in congestive heart failure. Curr Opin Cardiol. 1997 May;12(3):224–232. doi: 10.1097/00001573-199705000-00003. [DOI] [PubMed] [Google Scholar]
  15. Henry W. L., Gardin J. M., Ware J. H. Echocardiographic measurements in normal subjects from infancy to old age. Circulation. 1980 Nov;62(5):1054–1061. doi: 10.1161/01.cir.62.5.1054. [DOI] [PubMed] [Google Scholar]
  16. Jones N. L. Evaluation of a microprocessor-controlled exercise testing system. J Appl Physiol Respir Environ Exerc Physiol. 1984 Nov;57(5):1312–1318. doi: 10.1152/jappl.1984.57.5.1312. [DOI] [PubMed] [Google Scholar]
  17. Jones N. L., Summers E., Killian K. J. Influence of age and stature on exercise capacity during incremental cycle ergometry in men and women. Am Rev Respir Dis. 1989 Nov;140(5):1373–1380. doi: 10.1164/ajrccm/140.5.1373. [DOI] [PubMed] [Google Scholar]
  18. Jones S., Elliott P. M., Sharma S., McKenna W. J., Whipp B. J. Cardiopulmonary responses to exercise in patients with hypertrophic cardiomyopathy. Heart. 1998 Jul;80(1):60–67. doi: 10.1136/hrt.80.1.60. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Keeling P. J., Gang Y., Smith G., Seo H., Bent S. E., Murday V., Caforio A. L., McKenna W. J. Familial dilated cardiomyopathy in the United Kingdom. Br Heart J. 1995 May;73(5):417–421. doi: 10.1136/hrt.73.5.417. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. LeJemtel T. H., Maskin C. S., Lucido D., Chadwick B. J. Failure to augment maximal limb blood flow in response to one-leg versus two-leg exercise in patients with severe heart failure. Circulation. 1986 Aug;74(2):245–251. doi: 10.1161/01.cir.74.2.245. [DOI] [PubMed] [Google Scholar]
  21. Marriott J. B., Goldman J. H., Keeling P. J., Baig M. K., Dalgleish A. G., McKenna W. J. Abnormal cytokine profiles in patients with idiopathic dilated cardiomyopathy and their asymptomatic relatives. Heart. 1996 Mar;75(3):287–290. doi: 10.1136/hrt.75.3.287. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Messner-Pellenc P., Brasileiro C., Ahmaidi S., Mercier J., Ximenes C., Grolleau R., Préfaut C. Exercise intolerance in patients with chronic heart failure: role of pulmonary diffusing limitation. Eur Heart J. 1995 Feb;16(2):201–209. doi: 10.1093/oxfordjournals.eurheartj.a060886. [DOI] [PubMed] [Google Scholar]
  23. Michels V. V., Moll P. P., Miller F. A., Tajik A. J., Chu J. S., Driscoll D. J., Burnett J. C., Rodeheffer R. J., Chesebro J. H., Tazelaar H. D. The frequency of familial dilated cardiomyopathy in a series of patients with idiopathic dilated cardiomyopathy. N Engl J Med. 1992 Jan 9;326(2):77–82. doi: 10.1056/NEJM199201093260201. [DOI] [PubMed] [Google Scholar]
  24. Piepoli M., Clark A. L., Volterrani M., Adamopoulos S., Sleight P., Coats A. J. Contribution of muscle afferents to the hemodynamic, autonomic, and ventilatory responses to exercise in patients with chronic heart failure: effects of physical training. Circulation. 1996 Mar 1;93(5):940–952. doi: 10.1161/01.cir.93.5.940. [DOI] [PubMed] [Google Scholar]
  25. Richardson P., McKenna W., Bristow M., Maisch B., Mautner B., O'Connell J., Olsen E., Thiene G., Goodwin J., Gyarfas I. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation. 1996 Mar 1;93(5):841–842. doi: 10.1161/01.cir.93.5.841. [DOI] [PubMed] [Google Scholar]
  26. Schiller N. B., Shah P. M., Crawford M., DeMaria A., Devereux R., Feigenbaum H., Gutgesell H., Reichek N., Sahn D., Schnittger I. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1989 Sep-Oct;2(5):358–367. doi: 10.1016/s0894-7317(89)80014-8. [DOI] [PubMed] [Google Scholar]
  27. Sullivan M. J., Higginbotham M. B., Cobb F. R. Increased exercise ventilation in patients with chronic heart failure: intact ventilatory control despite hemodynamic and pulmonary abnormalities. Circulation. 1988 Mar;77(3):552–559. doi: 10.1161/01.cir.77.3.552. [DOI] [PubMed] [Google Scholar]
  28. Winter U. J., Gitt A. K., Blaum M., Fritsch J., Berge P. G., Pothoff G., Hilger H. H. Kardiopulmonale Leistungsfähigkeit bei Patienten mit koronarer Herzkrankheit. Z Kardiol. 1994;83 (Suppl 3):73–82. [PubMed] [Google Scholar]

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