Background-A decreased ratio of early to late diastolic mitral inflow velocities (E/A Ͻ1.0) reflects slowing of left ventricular (LV) relaxation. This finding is widely believed to indicate significant diastolic dysfunction. However, E/A Ͻ1.0 is common during normal aging and often is not associated with symptoms of heart failure. We asked (1) whether slowed LV relaxation is associated with exercise intolerance and (2) whether tissue Doppler imaging of the early diastolic mitral annular velocity (Ea) is helpful in understanding mechanisms of exercise intolerance. Methods and Results-Patients (nϭ121) underwent echocardiography before maximal exercise testing. Fifty-nine subjects had E/A Ͻ1.0, and 36 subjects had E/Ea Ն10. Exercise capacity was similar in the population with a normal mitral inflow pattern and those with a slow relaxation pattern when E/Ea was Ͻ10. In contrast, the subjects with slow relaxation and E/Ea Ն10 had reduced exercise tolerance. Of all the echo and clinical parameters assessed, E/Ea had the best correlation with exercise capacity (rϭϪ0.684, PϽ0.001) and was the strongest independent predictor of exercise capacity Յ7 METs by multivariate analysis (prevalence-corrected odds ratioϭ12.6, PϽ0.001). E/Ea continued to be strongly associated with exercise capacity in all age groups and in those with preserved or reduced systolic function. Conclusions-Of the subjects with slow LV relaxation, only those with E/Ea Ն10 have objective evidence of reduced exercise tolerance. These data suggest that elevated LV filling pressures rather than slow relaxation per se reduce exercise capacity.
Peripartum cardiomyopathy is an unusual and uncommon form of dilated cardiomyopathy that is often fatal to young women. Fetal outcome, however, is quite good. The disease occurs in 250-1350 women each year in the United States. Myocarditis of viral, immunologic, or idiopathic etiology has been suggested. Diagnostic findings are consistent with congestive heart failure. Primary therapy consists of bed rest, sodium and fluid restriction, vasodilators, digoxin, and diuretics. Refractory cases can be treated with cardiac transplantation. Selected patients require anticoagulation. Prognosis depends on 6-month recovery of left ventricular function. It is important to emphasize that functional recovery does not denote total recovery of cardiac function; this is critical in terms of future pregnancies. This article presents the case of a young woman with peripartum cardiomyopathy and a review of the literature. (c)2001 by CHF, Inc.
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