Circulation, Vol 81, 978-986, Copyright © 1990 by American Heart Association
A Cuocolo, FL Sax, JE Brush, BJ Maron, SL Bacharach and RO Bonow
Left ventricular ejection fraction is normal at rest but may respond
abnormally to exercise in many patients with essential hypertension. To
assess the determinants of the abnormal ejection fraction response to
exercise, we performed radionuclide angiography at rest and during exercise
in 41 hypertensive patients without coronary artery disease. In 22 patients
(group 1), the ejection fraction increased more than 5% during exercise; in
the other 19 patients (group 2), the ejection fraction either increased by
less than 5% or decreased with exercise. Left ventricular diastolic filling
was impaired at rest in patients in group 2 compared with group 1, with
reduced peak filling rate (2.5 +/- 0.4 vs. 3.1 +/- 0.7 end-diastolic
volume/sec; p less than 0.01) and prolonged time to peak filling rate (175
+/- 28 vs. 153 +/- 22 msec; p less than 0.01). Impaired diastolic filling
in group 2 was associated with less augmentation in end-diastolic volume
during exercise compared with group 1 (p less than 0.01). These
observations were not dependent on the threshold value that was arbitrarily
chosen to define an abnormal ejection fraction response, as there were
significant correlations for the entire group between the magnitude of
change in ejection fraction with exercise and both the resting peak filling
rate (r = 0.46) and the change in end-diastolic volume with exercise (r =
0.62).(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Left ventricular hypertrophy and impaired diastolic filling in essential hypertension. Diastolic mechanisms for systolic dysfunction during exercise
Department of Nuclear Medicine, Warren G. Magnuson Clinical Center, Bethesda, Maryland.
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