Related Experiment Videos
Exertional hemodynamics in women with chest pain--an aortic Doppler ultrasound study
B J Sjöberg1, E Swahn, B Wranne
1Department of Clinical Physiology, Linköping Heart Center, University Hospital, Sweden.
Insights
Doppler ultrasound effectively assesses exercise-induced hemodynamic changes in women with coronary artery disease (CAD). This non-invasive method helps evaluate left ventricular function, aiding diagnosis in patients with chest pain.
Area of Science:
- Cardiovascular Physiology
- Diagnostic Imaging
- Exercise Cardiology
Background:
- Aortic Doppler ultrasound parameters like stroke volume, maximal flow velocity, and acceleration can assess central hemodynamic responses to exercise.
- Coronary artery disease (CAD) and left ventricular dysfunction can alter these hemodynamic responses.
- Electrocardiographic (ECG) ST-segment depression during exercise is common in women, complicating diagnosis.
Purpose of the Study:
- To evaluate the time course and amplitude of changes in aortic Doppler ultrasound parameters during supine exercise in women.
- To assess the diagnostic value of a submaximal supine exercise test using Doppler ultrasound.
- To characterize left ventricular function in women with suspected CAD and chest pain.
Main Methods:
- 18 women with suspected CAD (10 with stenoses/infarction, 8 without) and 10 healthy controls underwent supine exercise testing.
- Aortic Doppler ultrasound measured stroke volume, maximal flow velocity, and acceleration.
- Coronary angiography and ECG were used for diagnosis and comparison.
Main Results:
- Healthy controls showed significant increases in stroke volume, maximal flow velocity, and acceleration during exercise.
- Women with CAD exhibited blunted increases and lower cardiac output, indicating left ventricular dysfunction.
- Women with syndrome X showed higher resting maximal flow velocity, suggesting hyperdynamic circulation.
Conclusions:
- A submaximal supine exercise test (up to 40% seated maximal load) using Doppler ultrasound is valuable for assessing hemodynamic effects.
- Doppler ultrasound can characterize left ventricular function in women with chest pain, especially when stress ECG results are equivocal.
- This technique may improve the understanding and clinical management of cardiovascular conditions in women.
Abstract:
Aortic ultrasound Doppler recordings of stroke volume, maximal flow velocity, and acceleration can be used to assess central hemodynamic effects of exercise in coronary artery disease (CAD) and left ventricular dysfunction. We wanted to evaluate the time course and amplitude of changes in aortic Doppler ultrasound parameters in women during supine exercise and the potential diagnostic value of a submaximal supine exercise test. For this purpose, 18 women who had undergone coronary angiography because of incapacitating chest pain (10 with significant coronary stenoses and previous myocardial infarction, 8 without stenoses or infarction) were compared with 10 healthy controls. Pathological electrocardiographic (ECG) ST-segment depression during supine exercise was common in all groups. In the control group, a significant increase of stroke volume (10%), maximal aortic flow velocity (27%), and acceleration (43%) occurred at low load during exercise. Women with CAD showed no increase and a lower cardiac output during exercise, indicating left ventricular dysfunction. Women with syndrome X resembled the controls but had a higher maximal flow velocity at rest, which may indicate hyperdynamic circulation. We conclude that a test up to 40% of seated maximal load is valuable and often sufficient when assessing the hemodynamic effects of supine exercise by Doppler ultrasound in terms of stroke volume, maximal flow velocity, and acceleration. By characterizing left ventricular function in groups of female patients where false-positive stress ECG reactions are common, Doppler ultrasound may contribute to the understanding and clinical management of women with chest pain.