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Adaptation of the left ventricular function parameters to dynamic exercise in aortic stenosis
J P Bassand1, D Ducellier, J R Lusson
1Hopital Saint Jacques, Besancon, France.
European Heart Journal
|April 1, 1988
Summary
In aortic stenosis patients, left ventricular function during exercise depends more on diastolic properties and hypertrophy than systolic function or valve severity. This impacts cardiac adaptation strategies.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Medical Imaging
Background:
- Aortic stenosis (AS) is a significant valvular heart disease.
- Understanding left ventricular (LV) adaptation to exercise in AS is crucial for management.
- Previous studies have explored various aspects of LV function in AS.
Purpose of the Study:
- To non-invasively assess LV volumes, ejection fraction, stroke volume index, and cardiac index at rest and during exercise in patients with moderate to severe pure AS.
- To investigate the relationships between stroke volume variations and other hemodynamic and structural parameters in AS.
- To determine the primary determinants of LV pump function adaptation during exercise in AS.
Main Methods:
- Utilized radionuclide angiography for non-invasive assessment of LV function in 47 AS patients.
- Measurements were taken at rest and during peak supine exercise.
- Patients also underwent cardiac catheterization and coronary angiography.
Main Results:
- LV ejection fraction significantly decreased during exercise (P < 0.01).
- End-systolic volume, end-diastolic volume, stroke volume index, and cardiac index significantly increased during exercise.
- Stroke volume variations correlated strongly with end-diastolic volume variations (r=0.84) and inversely with LV mass (r=-0.42).
- No significant relationship was found between stroke volume index variations and systolic gradient, aortic valve area, or resting LV ejection fraction.
Conclusions:
- LV pump function adaptation during exercise in AS is primarily influenced by diastolic properties (diastolic stiffness) and LV hypertrophy.
- Basal systolic function and the severity of valvular obstruction appear to have limited impact on exercise adaptation in AS.
- These findings suggest a need to consider diastolic function in therapeutic strategies for AS.
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