Dr.S.Venkatesan MD

What   are the factors other than EF %  that determine  functional capacity in cardiac failure ?

In our experience we have found the following factors  contribute immensely to the functional capacity of cardiac failure patients

1. LV  filling  defects  (30 % of DCM have significant LV relaxation defects )*
2. Integrity of  RV  function
3. Mitral valve  competence(Even a mild MR can be important .It lowers the threshold for pulmonary congestion  )
4. Severity of Pulmonary hypertension
5. Lung Function *(Restrictive PFT common , gross cardiomegaly can reduce lung space )
6. Basal exercise capacity .
7. Skeletal muscle  function (Mitochondrial training )*
8. High body weight
9. Will power and self esteem *
10. Spouse support and motivation

* May  have  major Impact on functional capacity

Final message

Physicians and even cardiologists are   obsessed  with EF %  to a large extent . My guess is , it   is not likely to end in the near future . The irony is ,  we have passed it  to our  colleagues  (Like anesthetists !)  and patients as well .(  for various reasons )

                        Please remember  , there are at-least 10 factors  that are  important  in the genesis of  symptoms of heart failure  . The list can extend  further  if we include  like associated renal  dysfunction , hemoglobin concentration  , etc .

Even though LV pump primarily determines  the ultimate outcome in cardiac failure ,  it is unwise  to  blame the EF %  for all the suffering  . If only  we realise this fact , one  can take  appropriate  measures .

**   Paradoxically modalities aimed to improve LVEF by positive inotropics has never been shown to improve the outcome .In-fact , there is more evidence for the contrary !