Circulation, Vol 77, 543-551, Copyright © 1988 by American Heart Association
A Rassi Jr, MH Crawford, KL Richards and JF Miller
To determine the mechanisms by which blood flow increases across the mitral
and aortic valves during exercise, 18 normal men were studied during graded
supine and upright bicycle exercise at matched workloads. Mitral valve
orifice and ascending aortic blood velocities were recorded by Doppler
echocardiography during steady states at each stage of exercise.
Parasternal two-dimensional echocardiographic imaging of the ascending
aorta adjacent to the aortic valve orifice and the mitral valve orifice at
the tips of the valve leaflets was used to calculate changes in
cross-sectional area during exercise. Heart rate increased from rest to
exercise from 67 to 150 beats/min (124%) during supine exercise and from 72
to 147 beats/min (104%) during upright exercise. Stroke volume increased
20% during supine and 46% during upright exercise; the increase in stroke
volume was statistically significant when rest and exercise were compared
and when the magnitude of change was compared vs position (p less than
.05). The increase in stroke volume measured at the ascending aorta was
accomplished by an increase in the velocity-time integral (+15% supine and
+48% upright, p less than .05), with little change in aortic
cross-sectional area (5% supine and 0% upright, p = NS). By contrast, the
increase in flow rate measured at the mitral valve was predominantly due to
an increase in mean diastolic cross-sectional area (+29% supine and 34%
upright, p less than .05); the velocity-time integral did not increase
significantly (-10% supine and 4% upright; p = NS).(ABSTRACT TRUNCATED AT
250 WORDS)
ARTICLES
Differing mechanisms of exercise flow augmentation at the mitral and aortic valves
Division of Cardiology, University of Texas Health Science Center, San Antonio 78284-7872.
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