Abstract

Hemodynamik changes during exercise were evaluated in 20 patients with severe,chronic congestive heart failure. Two groups were identified by their stroke work response to maximal exercise. Group I (eight patients) showed an increasein stroke work index. This occurred because the stroke volume increased and the difference between mean systolic pressure and left ventricular filling pressure increased. Group II (12 patients) showed a decrease in stroke work index. This occurred because stroke volume decreased while the difference between mean systolic pressure and left ventricular filling pressure did not change. Despite hemodynamic differences, the groups could not be distinguishedby the usual clinical criteria for heart failure including etiology, New York Heart Association functional class, heart size on chest X-ray film or durationof heart failure. Clinical criteria are relatively insensitive in predicting the exercise hemodynamics of any given patient with chronic severe heart failure. Determining the exercise hemodynamics may be helpful as a means of assessing left ventricular functional reserve in heart failure. Prognostic implications, drug therapy and prescription of activitiesmay require adjustment based on this spectrum of hemodynamic response to exercise in patients with chronic heart failure. Verf.-Referat