Pressure-volume relationship during dobutamine stress echocardiography predicts exercise tolerance in patients with congestive heart failure.

BACKGROUND: The pressure-volume relationship (PVR) is a useful method for evaluating left ventricular (LV) myocardial contractility during dobutamine stress echocardiography (DSE). The investigators assessed PVRs, systolic and diastolic function, B-type natriuretic peptide (BNP) levels, and aerobic exercise capacity in patients with congestive heart failure (CHF). METHODS: A total of 84 patients with CHF (mean age, 68 +/- 9 years) underwent high-dose DSE. PVR was defined as the systolic cuff pressure/end-systolic volume index difference between rest and peak DSE. Of these, 67 patients also underwent cardiopulmonary exercise testing. The patients were divided into 3 equal groups on the basis of PVR: lower, intermediate, and higher. RESULTS: PVRs were significantly lower in more symptomatic patients (New York Heart Association class II vs III) (2.17 +/- 1.99 vs 0.91 +/- 0.72 mm Hg/mL/m(2), P .001). Patients with elevated LV filling pressures (E/Ea or