Relation between exercise-induced changes in ejection fraction and systolic loading conditions at rest in aortic regurgitation

M. E. Goldman, M. Packer, S. F. Horowitz, J. Meller, R. E. Patterson, M. Kukin, L. E. Teichholz, R. Gorlin

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

To examine the role of systolic wall stress at rest in determining left ventricular performance during exercise in aortic regurgitation (AR), systolic wall stress (measured by M-mode echocardiography) was related to changes in left ventricular function during maximal exercise evaluated by radionuclide ventriculography) in 30 patients with chronic aortic regurgitation. Of these 30 patients, 7 had a normal exercise response, defined as an absolute increase in ejection fraction of 5% or greater (Group I) and 23 had abnormal exercise response, defined as no change (< 5% change) or a decline (≤ 5%) in ejection fraction (Group II). Patients in Group I had a significantly lower radius/wall thickness ratio (2.5 ± 0.2 versus 3.1 ± 0.1, p < 0.01) and lower peak systolic wall stress (123 ± 11 versus 211 ± 12 x 103 dynes/cm2, p < 0.01) than patients in Group II. An increase in ejection fraction during exercise was seen in 6 of the 9 patients with normal systolic wall stress at rest (< 150 x 103 dynes/cm2), but in only 1 of 21 patients with elevated systolic wall stress (p < 0.001). Peak systolic wall stress at rest varied linearly and inversely with changes in left ventricular ejection fraction during exercise (r = 0.60, p < 0.001). Groups I and II did not differ in ejection fraction at rest, clinical symptoms or maximal work load achieved. These findings suggest that exercise-induced left ventricular dysfunction in patients with aortic regurgitation is the result of elevated left ventricular systolic wall stress; both echocardiographic evaluation of wall stress at rest and radionuclide determination of the exercise response identify a similar patient group that may be at a high risk of persistent symptoms and left ventricular dysfunction after aortic valve replacement.

Original languageEnglish (US)
Pages (from-to)924-929
Number of pages6
JournalJournal of the American College of Cardiology
Volume3
Issue number4
DOIs
StatePublished - 1984

Fingerprint

Aortic Valve Insufficiency
Exercise
Left Ventricular Dysfunction
Radionuclide Ventriculography
Workload
Aortic Valve
Left Ventricular Function
Radioisotopes
Stroke Volume
Echocardiography

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Relation between exercise-induced changes in ejection fraction and systolic loading conditions at rest in aortic regurgitation. / Goldman, M. E.; Packer, M.; Horowitz, S. F.; Meller, J.; Patterson, R. E.; Kukin, M.; Teichholz, L. E.; Gorlin, R.

In: Journal of the American College of Cardiology, Vol. 3, No. 4, 1984, p. 924-929.

Research output: Contribution to journalArticle

Goldman, M. E. ; Packer, M. ; Horowitz, S. F. ; Meller, J. ; Patterson, R. E. ; Kukin, M. ; Teichholz, L. E. ; Gorlin, R. / Relation between exercise-induced changes in ejection fraction and systolic loading conditions at rest in aortic regurgitation. In: Journal of the American College of Cardiology. 1984 ; Vol. 3, No. 4. pp. 924-929.
@article{8b1ae899171048df954fa5f2e2ca0557,
title = "Relation between exercise-induced changes in ejection fraction and systolic loading conditions at rest in aortic regurgitation",
abstract = "To examine the role of systolic wall stress at rest in determining left ventricular performance during exercise in aortic regurgitation (AR), systolic wall stress (measured by M-mode echocardiography) was related to changes in left ventricular function during maximal exercise evaluated by radionuclide ventriculography) in 30 patients with chronic aortic regurgitation. Of these 30 patients, 7 had a normal exercise response, defined as an absolute increase in ejection fraction of 5{\%} or greater (Group I) and 23 had abnormal exercise response, defined as no change (< 5{\%} change) or a decline (≤ 5{\%}) in ejection fraction (Group II). Patients in Group I had a significantly lower radius/wall thickness ratio (2.5 ± 0.2 versus 3.1 ± 0.1, p < 0.01) and lower peak systolic wall stress (123 ± 11 versus 211 ± 12 x 103 dynes/cm2, p < 0.01) than patients in Group II. An increase in ejection fraction during exercise was seen in 6 of the 9 patients with normal systolic wall stress at rest (< 150 x 103 dynes/cm2), but in only 1 of 21 patients with elevated systolic wall stress (p < 0.001). Peak systolic wall stress at rest varied linearly and inversely with changes in left ventricular ejection fraction during exercise (r = 0.60, p < 0.001). Groups I and II did not differ in ejection fraction at rest, clinical symptoms or maximal work load achieved. These findings suggest that exercise-induced left ventricular dysfunction in patients with aortic regurgitation is the result of elevated left ventricular systolic wall stress; both echocardiographic evaluation of wall stress at rest and radionuclide determination of the exercise response identify a similar patient group that may be at a high risk of persistent symptoms and left ventricular dysfunction after aortic valve replacement.",
author = "Goldman, {M. E.} and M. Packer and Horowitz, {S. F.} and J. Meller and Patterson, {R. E.} and M. Kukin and Teichholz, {L. E.} and R. Gorlin",
year = "1984",
doi = "10.1016/S0735-1097(84)80350-2",
language = "English (US)",
volume = "3",
pages = "924--929",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "4",

}

TY - JOUR

T1 - Relation between exercise-induced changes in ejection fraction and systolic loading conditions at rest in aortic regurgitation

AU - Goldman, M. E.

AU - Packer, M.

AU - Horowitz, S. F.

AU - Meller, J.

AU - Patterson, R. E.

AU - Kukin, M.

AU - Teichholz, L. E.

AU - Gorlin, R.

PY - 1984

Y1 - 1984

N2 - To examine the role of systolic wall stress at rest in determining left ventricular performance during exercise in aortic regurgitation (AR), systolic wall stress (measured by M-mode echocardiography) was related to changes in left ventricular function during maximal exercise evaluated by radionuclide ventriculography) in 30 patients with chronic aortic regurgitation. Of these 30 patients, 7 had a normal exercise response, defined as an absolute increase in ejection fraction of 5% or greater (Group I) and 23 had abnormal exercise response, defined as no change (< 5% change) or a decline (≤ 5%) in ejection fraction (Group II). Patients in Group I had a significantly lower radius/wall thickness ratio (2.5 ± 0.2 versus 3.1 ± 0.1, p < 0.01) and lower peak systolic wall stress (123 ± 11 versus 211 ± 12 x 103 dynes/cm2, p < 0.01) than patients in Group II. An increase in ejection fraction during exercise was seen in 6 of the 9 patients with normal systolic wall stress at rest (< 150 x 103 dynes/cm2), but in only 1 of 21 patients with elevated systolic wall stress (p < 0.001). Peak systolic wall stress at rest varied linearly and inversely with changes in left ventricular ejection fraction during exercise (r = 0.60, p < 0.001). Groups I and II did not differ in ejection fraction at rest, clinical symptoms or maximal work load achieved. These findings suggest that exercise-induced left ventricular dysfunction in patients with aortic regurgitation is the result of elevated left ventricular systolic wall stress; both echocardiographic evaluation of wall stress at rest and radionuclide determination of the exercise response identify a similar patient group that may be at a high risk of persistent symptoms and left ventricular dysfunction after aortic valve replacement.

AB - To examine the role of systolic wall stress at rest in determining left ventricular performance during exercise in aortic regurgitation (AR), systolic wall stress (measured by M-mode echocardiography) was related to changes in left ventricular function during maximal exercise evaluated by radionuclide ventriculography) in 30 patients with chronic aortic regurgitation. Of these 30 patients, 7 had a normal exercise response, defined as an absolute increase in ejection fraction of 5% or greater (Group I) and 23 had abnormal exercise response, defined as no change (< 5% change) or a decline (≤ 5%) in ejection fraction (Group II). Patients in Group I had a significantly lower radius/wall thickness ratio (2.5 ± 0.2 versus 3.1 ± 0.1, p < 0.01) and lower peak systolic wall stress (123 ± 11 versus 211 ± 12 x 103 dynes/cm2, p < 0.01) than patients in Group II. An increase in ejection fraction during exercise was seen in 6 of the 9 patients with normal systolic wall stress at rest (< 150 x 103 dynes/cm2), but in only 1 of 21 patients with elevated systolic wall stress (p < 0.001). Peak systolic wall stress at rest varied linearly and inversely with changes in left ventricular ejection fraction during exercise (r = 0.60, p < 0.001). Groups I and II did not differ in ejection fraction at rest, clinical symptoms or maximal work load achieved. These findings suggest that exercise-induced left ventricular dysfunction in patients with aortic regurgitation is the result of elevated left ventricular systolic wall stress; both echocardiographic evaluation of wall stress at rest and radionuclide determination of the exercise response identify a similar patient group that may be at a high risk of persistent symptoms and left ventricular dysfunction after aortic valve replacement.

UR - http://www.scopus.com/inward/record.url?scp=0021361550&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0021361550&partnerID=8YFLogxK

U2 - 10.1016/S0735-1097(84)80350-2

DO - 10.1016/S0735-1097(84)80350-2

M3 - Article

C2 - 6707358

AN - SCOPUS:0021361550

VL - 3

SP - 924

EP - 929

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 4

ER -