+ Site Statistics
References:
54,258,434
Abstracts:
29,560,870
PMIDs:
28,072,757
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Exercise testing in asymptomatic or minimally symptomatic aortic regurgitation: relationship of left ventricular ejection fraction to left ventricular filling pressure during exercise



Exercise testing in asymptomatic or minimally symptomatic aortic regurgitation: relationship of left ventricular ejection fraction to left ventricular filling pressure during exercise



Circulation 67(5): 1091-1100



Exercise radionuclide angiography is being used to evaluate left ventricular function in patients with aortic regurgitation. Ejection fraction is the most common variable analyzed. To better understand the rest and exercise ejection fraction in this setting, 20 patients with asymptomatic or minimally symptomatic severe aortic regurgitation were studied. All underwent simultaneous supine exercise radionuclide angiography and pulmonary gas exchange measurement and underwent rest and exercise measurement of pulmonary artery wedge pressure (PAWP) during cardiac catheterization. Eight patients had a peak exercise PAWP less than 15 mm Hg (group 1) and 12 had a peak exercise PAWP greater than or equal to 15 mm Hg (group 2). Group 1 patients were younger and more were in New York Heart Association class I. Group 1 patients also had a higher mean rest ejection fraction (0.64 +/- 0.08 vs 0.49 +/- 0.13, p less than 0.01, higher exercise ejection fraction (0.63 +/- 0.10 vs 0.40 +/- 0.18, p less than 0.01), lower end-systolic volume (38 +/- 13 vs 79 +/- 36 ml/m2, p less than 0.01) and higher peak oxygen uptake (24.9 +/- 5.1 vs 16.6 +/- 4.9 ml/kg/min, p less than 0.01) than group 2 patients. However, the two groups had similar cardiothoracic ratios, changes in ejection fractions with exercise, and rest and exercise regurgitant indexes. Using multiple regression analysis, the best correlate of the exercise PAWP was peak oxygen uptake (r = -0.78, p less than 0.01). No other measurement added significantly to the regression. When peak oxygen uptake was excluded, rest and exercise ejection fraction also correlated significantly (r = -0.62 and r = -0.60, respectively, p less than 0.01). Patients with asymptomatic or minimally symptomatic severe aortic regurgitation have a wide spectrum of cardiac performance in terms of the PAWP during exercise. The absolute rest and exercise ejection fraction and the level of exercise achieved are noninvasive variables that correlate with exercise PAWP in aortic regurgitation, but the change in ejection fraction with exercise by itself is not.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 005418297

Download citation: RISBibTeXText

PMID: 6299613

DOI: 10.1161/01.cir.67.5.1091


Related references

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, 1983

Clinical outcomes of exercise-induced pulmonary hypertension in subjects with preserved left ventricular ejection fraction: implication of an increase in left ventricular filling pressure during exercise. Heart 97(17): 1417-1424, 2011

Relationship Between Left Ventricular Ejection Fraction and Mortality in Asymptomatic and Minimally Symptomatic Patients With Severe Aortic Stenosis. Jacc. Cardiovascular Imaging 2018, 2018

Improvement in the prediction of exercise-induced elevation of left ventricular filling pressure in patients with normal left ventricular ejection fraction. Echocardiography 34(1): 78-86, 2016

Noninvasive prediction of the exercise-induced elevation in left ventricular filling pressure in post-heart transplant patients with normal left ventricular ejection fraction. Experimental and Clinical Cardiology 18(2): 63-72, 2013

Left ventricular shape and mass impact torsional dynamics in asymptomatic patients with chronic aortic regurgitation and normal left ventricular ejection fraction. International Journal of Cardiovascular Imaging 31(7): 1315-1326, 2016

Incremental Prognostic Utility of Left Ventricular Global Longitudinal Strain in Asymptomatic Patients With Significant Chronic Aortic Regurgitation and Preserved Left Ventricular Ejection Fraction. Jacc. Cardiovascular Imaging 11(5): 673-682, 2017

Left ventricular volume and ejection fraction response to exercise in aortic regurgitation. American Journal of Cardiology 51(8): 1379-1385, 1983

The predictive value of left ventricular myocardium mechanics evaluation in asymptomatic patients with aortic regurgitation and preserved left ventricular ejection fraction. A long-term speckle-tracking echocardiographic study. Echocardiography 35(9): 1277-1288, 2018

Mechanisms for an abnormal radionuclide left ventricular ejection fraction response to exercise in aortic regurgitation. Circulation 82(4 SUPPL 3): III137, 1990

Reproducibility of rest and exercise left ventricular ejection fraction and volumes in chronic aortic regurgitation. American Journal of Cardiology 59(15): 1361-1365, 1987

Correlation of oxygen consumption to left ventricular ejection fraction response to exercise in aortic regurgitation. Clinical Research 29(2): 495A, 1981

CME: long-term outcome in asymptomatic patients with severe aortic regurgitation, normal left ventricular ejection fraction, and severe left ventricular dilatation. Echocardiography 27(8): 915-922, 2011

Exercise echocardiography in asymptomatic patients with severe aortic stenosis and preserved left ventricular ejection fraction. Journal of Cardiovascular Ultrasound 22(1): 1-5, 2014

Radionuclide left ventricular ejection fraction response to exercise is related to contractile state in patients with aortic regurgitation. Journal of Nuclear Medicine 29(5 SUPPL): 744-745, 1988