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Left ventricular diastolic response to exercise in valvular aortic stenosis
C Movsowitz1, W G Kussmaul, W K Laskey
1Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, USA.
The American Journal of Cardiology
|February 1, 1996
Summary
Patients with aortic stenosis (AS) experience prolonged and suboptimal left ventricular (LV) relaxation during exercise. This impaired diastolic function leads to significantly elevated LV pressures, impacting exercise capacity.
Area of Science:
- Cardiology
- Exercise Physiology
- Biomedical Engineering
Background:
- Exercise significantly impacts hemodynamics in patients with valvular aortic stenosis (AS).
- Previous research highlighted increased late left ventricular (LV) diastolic filling pressure during exercise in AS patients.
- Limited data exists on the exercise response of early LV diastolic performance in AS.
Purpose of the Study:
- To investigate the exercise response of early left ventricular (LV) diastolic performance indexes in patients with aortic stenosis (AS).
- To compare LV diastolic function during exercise between AS patients and healthy controls.
Main Methods:
- Cardiac catheterization with catheter-tip manometer recordings in 11 AS patients and 5 controls.
- Measurements were taken at rest and during supine bicycle exercise.
- Analysis included pressure-derived LV diastolic performance indexes, isovolumic relaxation rate, and diastolic interval data.
Main Results:
- At rest and during exercise, AS patients exhibited elevated early, minimal, and late LV diastolic pressures compared to controls.
- The time to onset of isovolumic relaxation and minimal LV diastolic pressure was prolonged in AS patients, both at rest and during exercise.
- AS patients showed a diminished rate of LV pressure decay and isovolumic relaxation during exercise compared to controls.
Conclusions:
- The LV diastolic response to exercise in AS is characterized by suboptimal and prolonged relaxation and a reduced rate of LV pressure decay.
- These abnormalities in early diastolic function, combined with impaired chamber distensibility, contribute to significant elevations in LV diastolic pressures during exercise in AS.
- Findings underscore the importance of assessing diastolic function during exercise in AS management.