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Size, shape, and stamina: the impact of left ventricular geometry on exercise capacity

Carolyn S P Lam1, Jasmine Grewal, Barry A Borlaug

  • 1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.

Hypertension (Dallas, Tex. : 1979)
|March 11, 2010
PubMed

Insights

Cardiac structural remodeling, particularly concentric hypertrophy, significantly limits exercise capacity in adults. This pattern is linked to reduced heart function and chronotropic reserve, suggesting reverse remodeling may be beneficial.

Area of Science:

  • Cardiology
  • Exercise Physiology
  • Cardiac Imaging

Background:

  • Exercise capacity is influenced by cardiac function, but the role of structural remodeling is less understood.
  • Cardiac geometry, assessed by left ventricular mass index and relative wall thickness, can be categorized into distinct patterns.
  • Previous research has primarily focused on functional determinants of exercise tolerance, with limited investigation into structural changes.

Purpose of the Study:

  • To evaluate the association between different patterns of cardiac geometry and exercise capacity in a low-risk adult population.
  • To determine if specific types of left ventricular remodeling correlate with reduced exercise tolerance.
  • To investigate the impact of cardiac structure on physiological responses during exercise.

Main Methods:

  • A prospective exercise echocardiography database was used to identify 366 subjects (ejection fraction > or = 50%) without valvular disease, ischemia, or arrhythmias.
  • Cardiac geometry was classified into normal, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy based on left ventricular mass index and relative wall thickness.
  • Maximal exercise tolerance was assessed using the Bruce protocol, with results measured in metabolic equivalents.

Main Results:

  • Exercise capacity, measured in metabolic equivalents, was highest in normal geometry (9.9+/-2.8) and progressively lower in concentric remodeling (8.9+/-2.6), eccentric hypertrophy (8.6+/-3.1), and concentric hypertrophy (8.0+/-2.7) (P<0.02 for all vs. normal).
  • Left ventricular mass index and relative wall thickness showed negative correlations with exercise tolerance (r=-0.14, P=0.009 and r=-0.21, P<0.001, respectively).
  • Augmentation of heart rate and ejection fraction during exercise was blunted in concentric hypertrophy compared to normal geometry, even after adjusting for medications.

Conclusions:

  • Ventricular remodeling patterns are significantly associated with exercise capacity in low-risk adults.
  • Concentric hypertrophy is linked to the greatest limitation in exercise capacity, primarily due to reduced systolic and chronotropic reserve.
  • Strategies aimed at reverse remodeling may hold potential for preventing or treating functional decline in individuals with structural heart disease.

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