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Left ventricular diastolic functional reserve during exercise in patients with impaired myocardial relaxation at rest

Authors
 J-W Ha  ;  D Choi  ;  S Park  ;  E-Y Choi  ;  C-Y Shim  ;  J-M Kim  ;  J-A Ahn  ;  S-W Lee  ;  J K Oh  ;  N Chung 
Citation
 HEART, Vol.95(5) : 399-404, 2009 
Journal Title
HEART
ISSN
 1355-6037 
Issue Date
2009
MeSH
Diastole/physiology ; Echocardiography, Doppler/methods ; Elasticity/physiology* ; Exercise Test ; Exercise Tolerance/physiology* ; Female ; Humans ; Male ; Middle Aged ; Myocardial Contraction/physiology ; Rest/physiology ; Stroke Volume/physiology* ; Ventricular Function, Left/physiology*
Abstract
BACKGROUND: Patients with similar grade diastolic dysfunction at rest may have a spectrum of alterations in diastolic function during exercise.

OBJECTIVE: To evaluate (a) whether exercise could unmask further diastolic abnormalities not evident during rest; (b) whether diastolic functional reserve during exercise is associated with exercise capacity.

METHODS: 141 subjects (77 male, mean (SD) age 62 (9)) with abnormal left ventricular (LV) relaxation (mitral E/A <0.75) and/or deceleration time >240 ms, underwent graded supine bicycle exercise with simultaneous respiratory gas analysis and two-dimensional and Doppler echocardiographic study. Mitral inflow and annular velocities were measured at rest and during exercise. The LV diastolic function reserve index (DFRI) was calculated.

RESULTS: Patients were classified into two groups: group 1 (n = 64), DFRI <13.5; group 2 (n = 77), DFRI >or=13.5. The ratio of E/E' to stroke volume was used as an index of ventricular elastance (Ed). No significant differences between the groups in mitral inflow and annular velocities at rest were found. Mean (SD) Ed was not significantly different at rest between the groups (0.19 (0.07) vs 0.18 (0.06), p = 0.29). Ed was significantly higher during exercise in group 1 than in group 2 (25 W, 0.21 (0.09) vs 0.14 (0.04), p<0.001; 50 W, 0.22 (0.10) vs 0.15 (0.04), p<0.001). Group 1 subjects had a shorter exercise duration (8.2 (2.7) vs 9.4 (3.7) min, p = 0.04) and lower peak oxygen consumption (17.5 (4.5) vs 20.2 (5.4) ml/kg/min, p = 0.005).

CONCLUSIONS: Despite similar mitral flow and annular velocities at rest, different responses to exercise were seen in patients with abnormal LV relaxation at rest. Lower LV diastolic functional reserve was associated with higher ventricular elastance during exercise, and reduced exercise capacity.
Full Text
http://heart.bmj.com/content/95/5/399.long
DOI
10.1136/hrt.2008.145441
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Park, Sung Ha(박성하) ORCID logo https://orcid.org/0000-0001-5362-478X
Shim, Chi Young(심지영) ORCID logo https://orcid.org/0000-0002-6136-0136
Chung, Nam Sik(정남식)
Choi, Dong Hoon(최동훈) ORCID logo https://orcid.org/0000-0002-2009-9760
Choi, Eui Young(최의영) ORCID logo https://orcid.org/0000-0003-3732-0190
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/104833
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