Circulation, Vol 71, 458-465, Copyright © 1985 by American Heart Association
B Greenberg, B Massie, D Thomas, JD Bristow, M Cheitlin, D Broudy, J Szlachcic and G Krishnamurthy
We studied the exercise ejection fraction response in 56 patients with
chronic aortic insufficiency. All had left ventricular dilatation but
preserved resting ejection fraction and minimal or no symptoms. The
exercise ejection fraction increased by 0.05 units or greater in 18 (32%)
patients (group I), remained within 0.05 units of the resting value in 18
(32%) patients (group II), and fell by 0.05 units or greater in 20 (36%)
patients (group III). There were no significant differences among the
groups in left ventricular end-diastolic dimension, end-systolic dimension,
or fractional shortening by echocardiography or in resting left ventricular
volumes and ejection fraction by radionuclide angiography. Left ventricular
end-systolic wall stress was significantly higher in group III than in
either group I or group II (89 +/- 20 vs 70 +/- 18 and 69 +/- 17 X 10(3)
dyne/cm2; p less than .005). At peak exercise there were no differences
among groups in systolic blood pressure. However, end-systolic volume
increased from 65 +/- 28 to 77 +/- 36 ml/m2 in group III and fell from 50
+/- 21 to 28 +/- 18 ml/m2 in group I during exercise. Thus, at peak
exercise end-systolic volume was nearly three times greater in group III
than in group I. Although stress could not be determined directly during
exercise, the directional changes in its determinants suggest that it also
would have been higher in group III patients. A highly significant inverse
correlation was present between the ejection fraction response and the
change in end-systolic volume (r = -.87, p less than .0001).(ABSTRACT
TRUNCATED AT 250 WORDS)
ARTICLES
Association between the exercise ejection fraction response and systolic wall stress in patients with chronic aortic insufficiency
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