Dissociation Between Improvement in Left Ventricular Performance and Functional Class in Patients With Chronic Heart Failure

Resting left ventricular ejection fraction (LVEF) and functional capacity do not correlate in chronic heart failure patients treated with digitalis, diuretics, and angiotensin-converting enzyme inhibitors. We sought to determine whether substantial improvement in LVEF, as may occur during long-term β-blockade or after coronary artery bypass graft (CABG) surgery, leads consistently to improvement in functional class. Doppler echocardiogram and assessment of functional class were obtained at baseline and 12 months after initiation of β-blockade (87 patients) or CABG surgery (51 patients). At 12 months the effects of β-blockade were variableLVEF increased greatly by ≥11% (median value) in 45 patients (52%) and by