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Purpose: Acute myocardial infarction (AMI) impacts both systolic and diastolic functions and may reduce functional capacity, which is an important prognosis predictor. We sought to assess the relation between systolic and diastolic function and exercise performance, after AMI, exploring the main determinants of reduced exercise capacity.

Methods: One month after AMI, 157 patients (mean age 55,6±11,2 years; 84,7% males) were submited to anthropometric evaluation (body mass index (BMI), body fat percentage, waist perimeter), detailed doppler-echocardiography and cardiopulmonary exercise test. Systolic function was evaluated by 2D ejection fraction (2D-EF) and tissue doppler velocity (septal and lateral S'). Diastolic function was assessed by mitral inflow velocity profile (E and A velocities, E/A ratio, isovolumetric relaxation time (IVRT) and decelaration time (DT)), pulmonary vein flow pattern (Ard-Ar) and tissue doppler velocity (septal and lateral E' and E/E' ratio). Exercise capacity was evaluated by peak VO2, peak VO2/kg, VO2 at anaerobic threshold and exercise time.

Results: Functional capacity, assessed by VO2/kg, was determined by diastolic function parametres, namely by septal E' (r: 0,424; p<0,001), lateral E' (r: 0,326; p<0,001), septal E/E' (rs: 0,35; p<0,001) and lateral E/E' (rs: 0,248; p=0,002). There was a progressive decrease in VO2/kg across the classification in four grades of diastolic dysfunction (p=0,009). E/A ratio, IVRT, DT and Ard-Ar showed no significant association with VO2/kg. There was no significant correlation between 2D-EF, septal and lateral S' and any parameter of exercise capacity.

Determinants of reduced exercise capacity (defined as VO2/kg <25 mL/kg/min) were age, BMI, body fat percentage, septal and lateral E' and E/E'. After multivariate regression analysis (adjusted for age, sex and BMI), the best echocardiographic predictors of VO2/kg were septal E' and septal E/E' (β=-0,29; p=0,006).

Conclusions: In this group of post-AMI patients, exercise capacity was mainly determined by the degree of diastolic dysfunction. Echocardiographic diastolic parameteres are much stronger determinants of reduced exercise capacity than those of systolic dysfunction.

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The European Society of Cardiology
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