Patients with heart failure and similar left ventricular systolic dysfunction have differing exercise capacity. The aim of this study was to identify echocardiographic predictors of exercise capacity in Algerian patients with heart failure and systolic dysfunction.

We included 290 patients with class II (70%) or III (30%) heart failure with left ventricular ejection fraction below 40%. Six-minute walking test and cardiac color Doppler-echo, including tissue Doppler of mitral and tricuspid rings, were performed. Moderate and severe mitral regurgitation were considered as significant. Two groups were divided according to the median walking distance (290m): Group 1<290m and Group 2>290m.

Mitral regurgitation was detected in 215 patients (74%), which was significant in 87 (30%). Group 1 showed more significant mitral regurgitation (35 vs. 18%), increased left atrium area (27±1 vs. 241cm²), mitral E amplitude (88±65 vs. 72±3cm/s) and systolic pulmonary pressure (37±1 vs. 32±1mmHg, all P<0.05). By logistic regression analysis, only the presence of significant mitral regurgitation was independently associated with less walked distance (odds ratio: 3.44 95% confidence interval 1.02-11.66, P<0.05). By multiple linear regression, the only independent predictor of walked distance was left atrium area (r=0.25, beta coefficient: _6.52±2, P<0.01).

In patients with class II-III heart failure and left ventricular systolic dysfunction, the main echocardiographic predictors of exercise capacity are related to the presence of significant mitral regurgitation.