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Exercise testing in aortic regurgitation comparison of radio nuclide left ventricular ejection fraction with exercise performance at the anaerobic threshold and peak exercise



Exercise testing in aortic regurgitation comparison of radio nuclide left ventricular ejection fraction with exercise performance at the anaerobic threshold and peak exercise



American Journal of Cardiology 52(7): 801-808



Serial radionuclide left ventricular ejection fractions (EF) were measured during graded supine exercise in 16 control patients and 35 asymptomatic or minimally symptomatic patients with severe aortic regurgitation (AR). Simultaneous pulmonary gas exchange analysis permitted determination of the anaerobic threshold, which is the point during exercise at which lactic acid begins to accumulate in the blood. The EF and O2 uptake were measured at rest, anaerobic threshold and peak exercise. The mean EF (.+-. 1 SD) in control patients increased from 0.65 .+-. 0.06 at rest to 0.73 .+-. 0.05 at anaerobic threshold (P < 0.01). No further change in EF occurred between anaerobic threshold and peak exercise (0.73 .+-. 0.09). Peak O2 uptake in control patients was 20 .+-. 4 ml/kg per min. Patients with AR were classified into 2 groups based on a peak O2 uptake > 16 ml/kg per min (group I, n = 26) and < 16 ml/kg/min (group II, n = 9). In group I the mean O2 uptake at the anaerobic threshold and peak exercise was similar to or greater than that in control patients, whereas in group II patients it was less than in control patients. In group I, the mean rest EF (0.62 .+-. 0.07) was similar to that in control patients; there was no change at the anaerobic threshold (0.61 .+-. 0.10), and then it decreased at peak exercise (0.57 .+-. 0.12, P < 0.05). In group II, the mean rest EF (0.44 .+-. 0.12) was below that in control patients (P < 0.01); there was a decrease at the anaerobic threshold (0.35 .+-. 0.10, P < 0.01), and then it decreased further at peak exercise (0.30 .+-. 0.09, P < 0.05). The anaerobic threshold and peak O2 uptake reflect rest and exercise left ventricular EF in AR and may provide an additional approach of assessing cardiac performance in these patients. Exercise-induced changes in left ventricular EF should be based on the changes occurring before the anaerobic threshold, because changes between anaerobic threshold and peak exercise are of uncertain diagnostic value.

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Accession: 005418296

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PMID: 6624672



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