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Cardiac function during graded bicycle exercise: Doppler-echocardiographic findings in normal subjects and heart
C H Spes1, S D Schnaack, K Theisen
1Medizinische Klinik, Klinikum Innenstadt, Ludwig-Maximilians-Universität München, Germany.
Insights
Heart transplant recipients have altered atrial function affecting left ventricular filling. Doppler echocardiography shows impaired atrial contribution to filling, not necessarily due to ventricular damage.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiovascular Physiology
Background:
- Orthotopic heart transplantation alters donor heart anatomy and denervation.
- These changes may impact cardiac function, specifically left ventricular filling and systolic performance.
Purpose of the Study:
- To assess the effects of heart transplantation sequelae on left ventricular filling and systolic performance.
- To differentiate between ventricular myocardial damage and impaired atrial function in heart transplant recipients.
Main Methods:
- Doppler echocardiography was used to evaluate 16 heart transplant recipients and 10 normal controls.
- Measurements were taken at rest and during graded bicycle exercise to assess cardiac function.
Main Results:
- Global and regional systolic ventricular allograft function remained normal in recipients at rest and during exercise.
- Resting Doppler profiles indicated diminished atrial contribution to ventricular filling in transplant recipients.
- Heart transplant recipients exhibited a blunted heart rate response and increased mitral time-velocity integral during exercise, with no augmentation of atrial contribution to filling.
Conclusions:
- Altered transmitral flow profiles in heart transplant recipients are not indicative of ventricular myocardial damage.
- These flow profile alterations are likely related to impaired atrial function post-transplantation.
Abstract:
Orthotopic heart transplantation results in altered atrial anatomy and denervation of the donor heart. To assess the impact of these sequelae on left ventricular filling and systolic performance, 16 heart transplant recipients and 10 normal controls were evaluated by Doppler echocardiography at rest and during graded bicycle exercise. Global and regional systolic ventricular allograft function was normal at rest and during exercise. Resting Doppler profiles demonstrated diminished atrial contribution to ventricular filling in transplant recipients. The response to dynamic exercise was different in both groups; controls increased heart rate, while mitral time-velocity integral was unchanged. Heart transplant recipients, in contrast, showed a blunted heart rate response and increased time-velocity integral. Atrial contribution to ventricular filling was not augmented during exercise as in normal controls. Alterations in transmitral flow profiles in heart transplant recipients do not necessarily reflect ventricular myocardial damage, but may be related to impaired atrial function.