Effect of coronary artery disease on Doppler-derived parameters of aortic flow during upright exercise

Recent advances in Doppler echocardiography have made possible noninvasive determination of stroke volume, cardiac output and peak ejection velocity at rest. To determine the ability of Doppler to measure these variables and the effect of altered left ventricular (LV) function during upright treadmill exercise, 20 normal subjects (group I) and 17 patients with coronary artery disease (CAD) (group II) were studied. Stroke index response was similar in both groups. The increase in cardiac index was more rapid in group I subjects and reached a higher peak value at maximal exercise (8.6 +/- 2.5 vs 5.5 +/- 2.2 liters/min, p less than 0.001). Peak ejection velocity increased rapidly during exercise in group I subjects; it increased much less in group II patients. Differences were significant at each stage of exercise. Peak ejection velocity was 1.56 +/- 0.32 and 0.89 +/- 0.26 m/s in group I vs group II patients, respectively, at maximal exercise. Three responses were seen in group II subjects. Three patients, all with 1-vessel CAD and normal LV function at rest, showed a normal response, with an increase in peak ejection velocity of at least 80% (type I response). In 8 patients peak ejection velocity increased less than 80% (type II response) and in 6 patients it decreased at maximal exercise (type III). Type II and III responses were seen in patients with more severe CAD and LV dysfunction at rest. These data show a progressive difference in Doppler-derived variables in exercise between normal subjects and patients with CAD, which is greatest in patients with LV dysfunction at rest and multivessel CAD.