Left ventricular performance during prolonged exercise: absence of systolic dysfunction

2001 ◽  
Vol 100 (5) ◽  
pp. 529-537 ◽  
Author(s):  
Jack M. GOODMAN ◽  
Peter R. McLAUGHLIN ◽  
Peter P. LIU
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Ejection Fraction ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Prolonged Exercise ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Fatigue ◽  
Exercise Period

We assessed left ventricular systolic and diastolic performance during and after prolonged exercise under controlled conditions in a group of healthy, trained men. Previous studies have examined the effects of prolonged effort on left ventricular function, yet it remains unclear whether or not left ventricular dysfunction (e.g. cardiac fatigue) can be produced under such conditions. We studied 15 healthy men, aged 27±1 years (mean±S.E.M.). Subjects exercised on bicycles at a constant work rate (60% of maximum oxygen uptake per min) for 150 min. Measurements of gas exchange, blood pressure and haematocrit were obtained, concurrent with the assessment of left ventricular function using equilibrium radionuclide angiography, at rest, during exercise (every 30 min) and after 30 min of recovery. Fluid replacement was provided and monitored during the exercise period. The baseline resting and exercise ejection fractions were 66±2% and 78±2% respectively. During exercise, subjects consumed 1816±136 ml of fluid, and the haematocrit had increased at 120 min of exercise (from 47.2%±0.6 to 49.9±0.8%; P < 0.05). There was no change in either systolic or diastolic blood pressure throughout the exercise period, but heart rate drifted upwards from 141±2 beats/min after 30 min to 154±3 beats/min after 150 min (P < 0.05). There was a small decline (8%; P < 0.05) in end-diastolic volume at 150 min. No changes were observed in left ventricular ejection fraction, the pressure/volume ratio or end-systolic volume. After 30 min of sitting in recovery, heart rate was still higher than the pre-exercise value (84±3 compared with 69±2 beats/min; P < 0.05), as were measures of peak filling rate and time to peak filling (P < 0.05). The ejection fraction in the post-exercise recovery period was similar to the pre-exercise value. The results indicate that prolonged exercise of moderate duration may not induce abnormal left ventricular systolic function or cardiac fatigue during exercise.

scholarly journals Image quality to estimate ventricular ejection fraction by last year medical students improves after short courses of training

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Tobias Hüppe ◽  
Heinrich Volker Groesdonk ◽  
Thomas Volk ◽  
Stefan Wagenpfeil ◽  
Benedict Wallrich
Keyword(s):  
Medical Students ◽  
Ejection Fraction ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Transthoracic Echocardiography ◽  
Imaging Modality ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Abstract Background Transthoracic echocardiography is the primary imaging modality for diagnosing cardiac conditions but medical education in this field is limited. We tested the hypothesis that a structured theoretical and supervised practical course of training in focused echocardiography in last year medical students results in a more accurate assessment and more precise calculation of left ventricular ejection fraction after ten patient examinations. Methods After a theoretical introduction course 25 last year medical students performed ten transthoracic echocardiographic examination blocks in postsurgical patients. Left ventricular function was evaluated both with an eye-balling method and with the calculated ejection fraction using diameter and area of left ventricles. Each examination block was controlled by a certified and blinded tutor. Bias and precision of measurements were assessed with Bland and Altman method. Results Using the eye-balling method students agreed with the tutor’s findings both at the beginning (88%) but more at the end of the course (95.7%). The variation between student and tutor for calculation of area, diameter and ejection fraction, respectively, was significantly lower in examination block 10 than in examination block 1 (each p < 0.001). Students underestimated both the length and the area of the left ventricle at the outset, as complete imaging of the left heart in the ultrasound sector was initially unsuccessful. Conclusions A structured theoretical and practical transthoracic echocardiography course of training for last year medical students provides a clear and measurable learning experience in assessing and measuring left ventricular function. At least 14 examination blocks are necessary to achieve 90% agreement of correct determination of the ejection fraction.

Abstract 4375: Potential Effects of Immunoadsorption and Subsequent IgG Substitution on Cardiopulmonary Exercise in DCM Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Lars R Herda ◽  
Christiane Trimpert ◽  
Astrid Hummel ◽  
Ute Nauke ◽  
Pfeiffersche Stiftungen ◽  
...  
Keyword(s):  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
Cardiopulmonary Exercise

Recent data indicate that cardiac antibodies play an active role in the pathogenesis of dilated cardiomyopathy (DCM), and may contribute to cardiac dysfunction of DCM patients. Previous studies have suggested that immunoadsorption with subsequent IgG substitution (IA/IgG) improves left ventricular function in DCM. The potential influence of this immunomodulatory therapy on cardiopulmonary exercise remains to be elucidated. 60 patients with DCM ( n = 60, NYHA II-IV, left ventricular ejection fraction ≤ 45%) underwent either IA/IgG ( n = 30), or were followed up without IA ( n = 30). IA/IgG was performed in one course of five consecutive days. After three months we compared echocardiographic assessment of left ventricular function and spiroergometric exercise parameters in both groups. Left ventricular ejection fraction (LVEF) improved significantly in the IA/IgG group from 33.0 ± 1.2% to 40.1 ± 1.5% (p < 0.001 vs. control, p < 0.001 vs. baseline). In the control group, spiroergometric exercise parameters did not change during follow-up. In contrast, patients receiving IA/IgG improved significantly in the following parameters: peak oxygen uptake (peak VO 2 ; 17.3 ± 0.9 ml/min/kg to 21.8 ± 1.0 ml/min/kg; p < 0.01 vs. control, p < 0.01 vs. baseline), oxygen pulse (10.7 ± 0.7 ml/bpm to 13.6 ± 0.7 ml/bpm; p < 0.05 vs. control, p < 0.01 vs. baseline), and anaerobic threshold (VO 2 AT; 10.3 ± 0.5 ml/min/kg to 13.2 ± 0.5 ml/min/kg; p < 0.001 vs. control, p < 0.001 vs. baseline). The ventilatory response to exercise (V E /VCO 2 slope) decreased after IA/IgG therapy from 32.3 ± 1.5 to 28.7 ± 0.9 (p = 0.18 vs. controls, p = 0.02 vs. baseline), whereas there was no significant change in the control group after 3 months. IA/IgG therapy in DCM patients may induce improvement in echocardiographic and cardiopulmonary exercise parameters.

Verbesserte linksventrikuläre Ruhefunktion und -perfusion nach transluminaler koronarer Angioplastik

1991 ◽  
Vol 30 (02) ◽  
pp. 55-60
Author(s):  
R. Standke ◽  
F.-D. Maul ◽  
M. Kaltenbach ◽  
G. Hör ◽  
H. Klepzig
Keyword(s):  
Ejection Fraction ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Left Ventricular Ejection ◽  
Stress Tests ◽  
Ventricular Ejection Fraction ◽  
Before And After ◽  
Exercise Induced

The purpose of this study was to evaluate left ventricular function and perfusion at rest before and after percutaneous transluminal coronary angioplasty. In consecutive 69 patients in whom coronary stenoses were dilated, the radionuclide left ventricular ejection fraction at rest increased significantly. In 26 of these patients, the ejection fraction increased by at least 4%. In these patients, exercise-induced ischemic ST depression had been more pronounced than in the others. 36 other patients underwent 201TI myocardial scintigraphy before and after angioplasty. Twelve patients in whom pre-PTCA images had revealed regions with irreversible 201TI uptake defects, showed normal 201TI distribution patterns on post-PTCA scintigrams. Post-exercise 201TI uptake (representing myocardial perfusion and metabolic activity) during pre-PTCA exercise stress tests was significantly lower in these cases. It is concluded that PTCA can improve left ventricular function and perfusion at rest. This improvement is most obvious in patients with pronounced exercise-induced myocardial ischemia as diagnosed by typical ST segment depression and reduced thallium uptake.

P2614Comparison of global longitudinal strain and ejection fraction in correlation to NT-proBNP in ischemic and non-ischemic heart failure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Ablasser ◽  
D Von Lewinski ◽  
E Kolesnik ◽  
M Gangl ◽  
L Kattnig ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Speckle Tracking ◽  
Longitudinal Strain ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection

Abstract Background In chronic heart failure (CHF) NT-proBNP and left ventricular ejection fraction (LVEF) by echocardiography are standard diagnostic as well as follow-up markers and are known to correlate with prognosis. Speckle-tracking echocardiography is a more recent technique to quantify myocardial deformation as a measurement of left ventricular function with potential benefits over LVEF. Purpose The purpose of this investigation was to analyse the cross-sectional relationship between 2D speckle tracking-derived global longitudinal strain (GLS) and NT-proBNP plasma levels in a prospective cohort of ischemic and non-ischemic CHF patients. Methods We enrolled 205 patients with chronic heart failure. Major inclusion criteria were age over 18 years, stable disease with absence of unplanned hospitalization or change in medication or device therapy in the previous month or major surgery in the previous 3 months. CHF treatment had to be according to the recommendations of the ESC CHF guidelines 2016 and LVEF had to be below 50%. Patient history, physical examination and an extensive echocardiography exam were performed. Lab results included NT-proBNP. Manual longitudinal strain was calculated using EchoPAC (General Electric Medical Systems, Horten, Norway) by a single and blinded examiner. LVEF was measured using Simpson's biplane method. Results 205 patients included in the study. The baseline characteristics included mean age 65.0 years and 75% male. Mean GLS was −9.6% (SD ±4.5%) and median NT-proBNP 1269.5 (IQR 379.5–2759.5) ng/ml. The CHF aetiology was 70.0% ischemic vs 30.0% non-ischemic. There was a significant negative correlation between GLS and NT-proBNP (Pearson r=0.239, p=0.029), this was not significant for LVEF and NT-proBNP (Pearson r=0.149, p=0.228).In a multivariate regression analysis adjusted for age, sex, NYHA classification and HF aetiology, GLS remained significantly correlated with NT-proBNP (adjusted beta-coefficient= 0.289, p=0.011). Furthermore, in contrast to LVEF, GLS showed a significant correlation to NT-proBNP in patients with ischemic (Pearson r=0.266, p=0.049) as well as non-ischemic aetiology of heart failure (Pearson r=0.434, p=0.034). Conclusion Global longitudinal strain, not LVEF, was significantly correlated with NT-proBNP in patients with CHF, independently of age, sex, symptoms or heart failure aetiology. This shows that speckle-tracking might be superior to LVEF for the assessment of left ventricular function in CHF.

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