Cardiac function following prolonged exercise: influence of age

2011 ◽  
Vol 110 (6) ◽  
pp. 1541-1548 ◽  
Author(s):  
Laura Banks ◽  
Zion Sasson ◽  
Sam Esfandiari ◽  
Gian-Marco Busato ◽  
Jack M. Goodman
Keyword(s):  
Diastolic Function ◽  
Prolonged Exercise ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Middle Aged ◽  
Post Exercise ◽  
Lv Dysfunction ◽  
Stress Echo ◽  
Dobutamine Dose

This study sought to determine the influence of age on the left ventricular (LV) response to prolonged exercise (PE; 150 min). LV systolic and diastolic performance was assessed using echocardiography (ECHO) before (pre) and 60 min following (post) exercise performed at 80% maximal aerobic power in young (28 ± 4.5 years; n = 18; mean ± SD) and middle-aged (52 ± 3.9 years; n = 18) participants. LV performance was assessed using two-dimensional ECHO, including speckle-tracking imaging, to determine LV strain (LV S) and LV S rate (LV SR), in addition to Doppler measures of diastolic function. We observed a postexercise elevation in LV S (young: −19.5 ± 2.1% vs. −21.6 ± 2.1%; middle-aged: −19.9 ± 2.3% vs. −20.8 ± 2.1%; P < 0.05) and LV SR (young: −1.19 ± 0.1 vs. −1.37 ± 0.2; middle-aged: −1.20 ± 0.2 vs. −1.38 ± 0.2; P < 0.05) during recovery in both groups. Diastolic function was reduced during recovery, including the LV SR ratio of early-to-late atrial diastolic filling (SRe/a), in young (2.35 ± 0.7 vs. 1.89 ± 0.5; P < 0.01) and middle-aged (1.51 ± 0.5 vs. 1.05 ± 0.2; P < 0.01) participants, as were conventional indices including the E/A ratio. Dobutamine stress ECHO revealed a postexercise depression in LV S in response to increasing dobutamine dose, which was similar in both young (pre-exercise dobutamine 0 vs. 20 μg·kg−1·min−1: −19.5 ± 2.1 vs. −27.2 ± 2.2%; postexercise dobutamine 0 vs. 20 μg·kg−1·min−1: −21.6 ± 2.1 vs. −23.7 ± 2.2%; P < 0.05) and middle-aged participants (pre: −19.9 ± 2.3 vs. −25.3 ± 2.7%; post: −20.8 ± 2.1 vs. −23.5 ± 2.7; P < 0.05). This was despite higher noradrenaline concentrations immediately postexercise in the middle-aged participants compared with young (4.26 ± 2.7 nmol/L vs. 3.00 ± 1.4 nmol/L; P = 0.12). These data indicate that LV dysfunction is observed following PE and that advancing age does not increase the magnitude of this response.

Abstract 1654: Reduced Left Ventricular Diastolic Function Follows Prolonged Strenuous Exercise In Middle-aged Male Athletes

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Sarah A Ramer ◽  
Zion Sasson ◽  
Gian-Marco Busato ◽  
Joan A Persaud ◽  
Amrit A Malik ◽  
...  
Keyword(s):  
Diastolic Function ◽  
Prolonged Exercise ◽  
Left Ventricular ◽  
Strenuous Exercise ◽  
Middle Aged ◽  
Experimental Conditions ◽  
Male Athletes ◽  
Mitral Inflow ◽  
Significant Prolongation ◽  
Middle Aged Male

Introduction: A number of studies have demonstrated LV diastolic dysfunction after prolonged strenuous exercise. However, data remain conflicting in part because of uncontrolled and disparate experimental conditions. Hypothesis: We assessed the hypothesis that a decline in LV diastolic function follows prolonged exercise among middle aged male athletes. Methods: Eight middle aged recreational male athletes (ages 47–59, mean 52.4± 1.3 years) were recruited. On separate days at least one week apart, subjects performed continuous running of 150 min duration at low and high intensities (55% vs 80% VO2 max, respectively). On each day of exercise, subjects underwent echocardiographic assessments immediately before and 60 min following exercise. Diastolic function was assessed by standard pulsed wave Doppler and tissue Doppler techniques. Efforts were made to maintain hydration throughout, and hematocrit was checked with each echocardiographic assessment. Results: Sixty minutes following prolonged exercise, the mean resting heart rate was significantly elevated compared to baseline (81±5 vs 63±3 bpm, p<0.01) and a drop in systolic blood pressure was observed (115±4 vs 132±5mmHg, p=0.02). Baseline and post-exercise hematocrit were similar (43.3%±0.8 vs 43.4%±0.8). Mean (±sem) indices of diastolic function are summarized below and included a significant decline in peak mitral inflow E velocity, accompanied by an increase in mitral inflow A velocity which was significant after high intensity exercise. The decline in both the E/A and e’/a’ ratio was significant for both high and low exercise intensities. A significant prolongation in the IVRT and the mitral inflow E wave deceleration time were seen following low intensity exercise. Conclusions: In middle aged men, prolonged exercise is associated with diminished resting LV diastolic performance, detectable one hour following exercise. These changes appear to be independent of hydration state.

Abstract 649: Increased Left Ventricular Filling Pressure is Associated with Left Atrial Thrombus in Patients with Atrial Fibrillation.

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Katsuomi Iwakura ◽  
Hiroshi Ito ◽  
Atsunori Okamura ◽  
Yasushi Koyama ◽  
Motoo Date ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Diastolic Function ◽  
Left Atrial ◽  
Multivariate Logistic Regression Analysis ◽  
Left Ventricular ◽  
Filling Pressure ◽  
Diastolic Filling ◽  
Ventricular Filling Pressure ◽  
Lv Diastolic Dysfunction ◽  
Ventricular Filling

Patients with atrial fibrillation (AF) are frequently associated with reduced left ventricular (LV) diastolic dysfunction. It is still unclear whether reduced diastolic function is associated with the risk of left atrial (LA) thrombus in AF. The ratio of transmitral E velocity to mitral annular velocity (e′) is an echocardiographic estimate of diastolic LV filling pressure even under AF rhythm. We investigated whether reduced LV diastolic function is associated with the risk of LA thrombus in AF patients, using E/e′ ratio as an index. We enrolled consecutive 405 patients with non-valvular, paroxysmal or chronic AF, who underwent both transthoracic- (TTE) and transesophagial echocardiography (TEE) examination within a month. We measured LA and LV dimensions, LV ejection fraction (%EF), wall thickness, E and e′ velocities on TTE, and determined E/e′ ratio. LA appendage thrombus was found in 33 patients (8.1%). Patients with LA thrombus showed lower e′ velocity (5.3±1.8 vs. 7.0±2.2 cm/s, p<.0001) and higher E/e′ ratio (17.2±9.2 vs. 11.5±5.9, p<.0001) than those without it. Using 12.4 as an optimal cutoff point, E/e′ predicted LA thrombus with 70% sensitivity and 70% specificity (AUC=0.72). Odds ratio for LA thrombus in patients in the highest quartile of E/e′ was 6.38 (3.06–13.9). Multivariate logistic regression analysis indicated that the highest quartiles of E/e′ ratio was an independent predictor of LA thrombus among echocardiographic parameters, along with LA dimension and %EF, whereas e′ was not. LA appendage flow velocity was significantly correlated with E/e′ ratio (p<.0001), implying that increased diastolic filling pressure could be associated with impaired blood flow within LA. Increased LV filling pressure increased the risk of LA thrombus in patients with AF, partially through impaired LA hemodynamics. E/e′ ratio on TTE could be useful for detecting high-risk patients for LA thrombus.

scholarly journals Model-Based Quantification of Left Ventricular Diastolic Function in Critically Ill Patients with Atrial Fibrillation from Routine Data: A Feasibility Study

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
Nicholas Kiefer ◽  
Maximilian J. Oremek ◽  
Andreas Hoeft ◽  
Sven Zenker
Keyword(s):  
Atrial Fibrillation ◽  
Diastolic Function ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Likelihood Function ◽  
External Validation ◽  
Left Ventricular ◽  
Monitoring Data ◽  
Diastolic Filling ◽  
Physiological Range

Introduction. Left ventricular diastolic dysfunction (LVDD) and atrial fibrillation (AF) are connected by pathophysiology and prevalence. LVDD remains underdiagnosed in critically ill patients despite potentially significant therapeutic implications since direct measurement cannot be performed in routine care at the bedside, and echocardiographic assessment of LVDD in AF is impaired. We propose a novel approach that allows us to infer the diastolic stiffness, β, a key quantitative parameter of diastolic function, from standard monitoring data by solving the nonlinear, ill-posed inverse problem of parameter estimation for a previously described mechanistic, physiological model of diastolic filling. The beat-to-beat variability in AF offers an advantageous setting for this. Methods. By employing a global optimization algorithm, β is inferred from a simple six parameter and an expanded seven parameter model of left ventricular filling. Optimization of all parameters was limited to the interval ]0, 400[ and initialized randomly on large intervals encompassing the support of the likelihood function. Routine ECG and arterial pressure recordings of 17 AF and 3 sinus rhythm (SR) patients from the PhysioNet MGH/MF Database were used as inputs. Results. Estimation was successful in 15 of 17 AF patients, while in the 3 SR patients, no reliable estimation was possible. For both models, the inferred β (0.065 ± 0.044 ml−1 vs. 0.038 ± 0.033 ml−1 (p=0.02) simple vs. expanded) was compatible with the previously described (patho) physiological range. Aortic compliance, α, inferred from the expanded model (1.46 ± 1.50 ml/mmHg) also compared well with literature values. Conclusion. The proposed approach successfully inferred β within the physiological range. This is the first report of an approach quantifying LVDF from routine monitoring data in critically ill AF patients. Provided future successful external validation, this approach may offer a tool for minimally invasive online monitoring of this crucial parameter.

Left ventricular long-axis diastolic function is augmented in the hearts of endurance-trained compared with strength-trained athletes

2002 ◽  
Vol 103 (3) ◽  
pp. 249-257 ◽  
Author(s):  
Dragos VINEREANU ◽  
Nicolae FLORESCU ◽  
Nicholas SCULTHORPE ◽  
Ann C. TWEDDEL ◽  
Michael R. STEPHENS ◽  
...  
Keyword(s):  
Oxygen Consumption ◽  
Ejection Fraction ◽  
Diastolic Function ◽  
Exercise Capacity ◽  
Peak Velocity ◽  
Maximal Oxygen Consumption ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Functional Reserve ◽  
Mitral Inflow

In order to determine left ventricular global and regional myocardial functional reserve in endurance-trained and strength-trained athletes, and to identify predictors of exercise capacity, we studied 18 endurance-trained and 11 strength-trained athletes with left ventricular hypertrophy (172±27 and 188±39g/m2 respectively), and compared them with 14 sedentary controls. Global systolic (ejection fraction) and diastolic (transmitral flow) function, and regional longitudinal and transverse myocardial velocities [tissue Doppler echocardiography (TDE)], were measured at rest and immediately after exercise. In endurance-trained compared with strength-trained athletes, resting heart rate was lower (59±11 and 76±9beats/min respectively; P<0.001), and the increase at peak exercise was greater (+211% and +139% respectively; P<0.001). In addition, exercise duration, workload, maximal oxygen consumption and global systolic functional reserve (but not peak ejection fraction) were higher in the endurance-trained athletes, and resting global diastolic function (E/A ratio 1.62±0.40 compared with 1.18±0.23; P<0.01) (where E-wave is peak velocity of early-diastolic mitral inflow and A-wave is peak velocity of mitral inflow during atrial contraction) and long-axis diastolic velocities (ETDE/ATDE ratio 2.2±1.2 compared with 1.1±0.3; P<0.01) (where ETDE and ATDE represent peak early- and late-diastolic myocardial or tissue velocity respectively) were augmented. Systolic velocities were similar. Exercise capacity was best predicted from end-diastolic diameter index and E/A ratio at rest, and end-diastolic volume index and diastolic longitudinal velocity during exercise (r = 0.74, n = 43, P<0.001). In conclusion, endurance-trained athletes had higher left ventricular long-axis diastolic velocities, augmented global early diastolic filling, and greater chronotropic and global systolic functional reserve. Maximal oxygen consumption was determined by diastolic loading and early relaxation rather than by systolic function, suggesting that dynamic exercise training improves cardiac performance by an effect on diastolic filling.

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