Relationship of exercise capacity to resting left ventricular performance and basal plasma norepinephrine levels in patients with congestive heart failure

Seventeen patients with chronic congestive heart failure (CHF) were studied to assess the relationship of resting left ventricular function, as measured by noninvasive and invasive methods, to maximal exercise capacity, as measured by peak total body oxygen consumption (V̇O₂). Supine basal plasma norepinephrine (NE) was also measured to evaluate its relationship to the severity of heart failure and to determine whether it may be a better predictor of exercise capacity in patients with CHF than the more commonly employed noninvasive and invasive tests of left ventricular function. Fourteen of the 17 patients underwent upright bicycle exercise (average peak V̇O₂ 10.60± 1.40 ml/kg/min, ±SEM) to their symptomatic maximum. There was no significant correlation between peak V̇O₂ and the noninvasive measurements of left ventricular performance obtained at rest, including cardiothoracic ratio, left ventricular internal dimension by M-mode echo, percent shortening of the minor axis by M-mode echo, and radionuclide ejection traction. Hemodynamic measurements were performed in 16 patients. The hemodynamic measurements at rest also failed to correlate with exercise capacity. The supine basal plasma NE, which was elevated in these 17 patients (612 ± 100 pg/ml), had an inverse relationship with stroke work index (r = -0.70, p< 0.01) and stroke index (r = - 0.83, p < 0.001) and a positive correlation with right atrial pressure (r = 0.81, p < 0.001). Although both noninvasive and invasive measurements at rest failed to correlate significantly with peak V̇O₂ during exercise, the plasma NE had a significant inverse correlation with peak exercise V̇O₂ (r = -0.50, p < 0.05).The basal supine plasma NE is therefore elevated in patients with CHF, is a marker for the severity of CHF as measured by hemodynamics performed at rest, and is a better predictor of exercise capacity than standard noninvasive and invasive tests performed at rest.