Left ventricular energetics: new insight into the plasticity of regional contributions at rest and during exercise

Although the human left ventricle (LV) operates as a functional syncytium and previous studies have reported a single value for LV stroke work at rest, more intricate plasticity of regional LV energetics may be required during enhanced cardiovascular demand. We compared kinetic energy of the LV base and apex, respectively, during ventricular contraction and relaxation at rest and during continuous and discontinuous incremental exercise. At rest, prior to both exercise trials, the accumulated kinetic energy during contraction and relaxation was significantly higher at the LV base compared with the apex (P ≤ 0.05). With increasing exercise intensity, kinetic energy during contraction increased significantly more at the LV base (interaction effect: P < 0.0001), while kinetic energy during relaxation increased significantly more at the apex during high-intensity exercise (interaction effect: P < 0.001). Total kinetic energy produced over the entire cardiac cycle was significantly greater at the LV apex during high exercise intensities (P < 0.05). We further show that the region-specific differences in kinetic energy at rest and during exercise are explained by significantly different wall mechanics, showing heterogenic contributions from radial, circumferential, and angular components at the base and apex, respectively. In conclusion, the present findings provide unique insight into human LV function by demonstrating that within this functional syncytium, significant differences in the regional contributions of kinetic energy to overall LV work exist. Importantly, regional contributions are not fixed but highly plastic and the underpinning LV wall energetics adjust according to the prevailing cardiovascular demand.