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Background: Six minute walking test (6-MWT) may serve as a reproducible test for assessing exercise capacity in heart failure (HF) patients and can be clinically predicted. We aimed in this study to ascertain if global markers of ventricular asynchrony can predict 6MWT distance in a group of patients with HF and left ventricular (LV) ejection fraction (EF) <45%., Methods and Results: This study included 77 consecutive patients (60 ± 12 years) with stable HF. LV end-diastolic and end-systolic dimensions, shortening fraction (SF), EF, myocardial velocities, t-IVT, and Tei index were measured, as well as 6-MWT distance. Patients with limited exercise performance (≤ 300 m) had lower SF (p = 0.02) and EF (p = 0.017), longer t-IVT (p = 0.001), higher Tei index (p = 0.002) and higher E/E' ratio (p < 0.001) compared with good performance patients. In multivariate analysis, only E/E' ratio [0.800 (0.665-0.961), p = 0.017], and t-IVT [0.769 (0.619-0.955), p = 0.018] independently predicted poor exercise performance., Conclusions: In heart failure patients, the higher the filling pressures and the more asynchronous the left ventricle, the poorer is the patient's exercise capacity. These findings highlight specific LV functional disturbances that should be targeted for better optimization of medical and/or electrical therapy., (Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.)

Objective: We investigated the prognostic value of various parameters on the mortality of patients with nonrheumatic chronic heart failure and left ventricular (LV) systolic dysfunction., Methods: This study included 132 consecutive patients with congestive heart failure and reduced LV systolic function without rheumatic valve disease. The primary outcome was mortality. Mean follow-up was 38+/-6 months., Results: During the follow-up period there were 47 deaths (35.6%). The age (64.1+/-13.5 vs. 58.7+/-11.8 years, P=0.019), left bundle branch block (44.7% vs. 18.8%, P=0.002), urea concentration (11.4+/-5.3 vs. 8.9+/-4.6 mmol/L, P=0.006), LV end-diastolic and end-systolic dimensions (6.7+/-0.8 vs. 6.4+/-0.8 cm, P=0.025 and 5.5+/-0.8 vs. 4.9+/-0.8 cm, P<0.001, respectively), grade 3-4 mitral regurgitation (40.4 vs. 22.4%, P<0.001), fractional shortening (16.7+/-5.3% vs. 19.8+/-5.7%, P=0.002) and LV ejection fraction (32.9+/-8.5% vs. 38.7+/-11.3%, P=0.003) were different between non-survivors and survivors. Multivariate analysis identified severity of mitral regurgitation (OR=1.99, 95% CI 1.18-3.34; P=0.009), age (OR=1.07, 95% CI 1.02-1.12; P=0.01) and LV end-systolic dimension (OR=1.09, 95% CI 1.02-1.16; P=0.014) as independent correlates of mortality., Conclusions: In medically treated patients with nonrheumatic chronic heart failure and left ventricular systolic dysfunction, severity of mitral regurgitation, age and enlarged LV end-systolic dimension were independently associated with increased risk of death.