[Echocardiographic contractility reserve and invasive hemodynamics in physical stress in probands with healthy hearts and patients with dilated cardiomyopathy].

In the present study, 17 patients with angiographically proven dilative cardiomyopathy (CM) were investigated simultaneously by both invasive right heart catheter and 1D/2D echocardiography at rest (R) and during bicycle exercise (E) stress test. They were compared with 14 normal subjects (N). The echocardiographic contractility reserve was determined as an increase in the systolic pump function (shortening fraction-SF, ejection fraction - EF) and compared with pulmonary capillary wedge pressure during exercise. 14/17 echocardiograms of dilative cardiomyopathy and all echocardiograms of normal subjects at rest as well as during exercise could be accepted. In N, echocardiographic parameters of systolic function significantly increased during exercise, whereas dilative cardiomyopathy showed decreased contractility reserve with no increase in pump function (for CM patients, at rest SF: 21.3% +/- 8%; EF: 41.6% +/- 14%; exercise SF: 21.3 +/- 9%; EF: 40.7% +/- 15%). Hemodynamic investigation in CM showed no increase in stroke volume accompanied by a pathologic increase in pulmonary wedge pressure, ranging from x = 16.4 mmHg at rest, up to 30.0 mm Hg in exercise (p less than 0.001), whereas in normal subjects, no pathologic increase in pressure was present (from 10.3 mm Hg at rest to 13.7 mm Hg during exercise). There were closed relations between invasive and non-invasive data. The relative alteration of stroke volume during E showed in N and in CM good correlation with echocardiography (N + 19%, CM -2%) and invasive data (N + 18%, CM + 2%). FSe during stress and PCPm showed a closed inverse correlation during exercise (p less than 0.001; r = 0.8). The lower the contractility in echocardiogram, the higher PCPm was in exercise.