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European Heart Journal 1986 7(2):118-126;
Copyright © 1986 by the European Society of Cardiology.
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© 1986 The European Society of Cardiology

Radionuclide assessment of a normal left ventricular response to exercise in patients without evidence of heart disease

H. R. SCHOEN, C. RIED, M. ARNHOLD-SCHNEIDER, H. SEBENING, E. SAUER, R. BAUER, H. W. PABST and H. BLOEMER

Divisions Cardiology and Nuclear Medicine, Klinikum rechts der Isar, Technical University Munich Munich F.R.G.

Received 25 March 1985; revised 21 August 1985; .

Address for correspondence: Hans R. Schoen, MD, Division, Cardiology, I. Med Klinik rechts der Isar, Technical University, Munich, ismaninger strasse 22,8000 Muenchen 80, F.R.G.

Abstract

The aim of this study was to define normal left ventricular performance at rest and during supine bicycle exercise with equilibrium radionuclide ventriculography in a normal population other than young healthy volunteers. Thirty-one patients (mean age 45 years ± 9 SD) with chest pain of varying origin andno evidence of heart disease proven by means of noninvasive and invasive techniques were studied. Left ventricular ejection fraction (LVEF) at rest averaged 0.64 ± 007 SD and increased with peak exercise to 0.73 ± 008 SD (P<0.005). Change in LVEF from rest to maximum exercise ranged within 0–0.19. Six patients (19%) failed to augment LVEF with exercise to more than 0.05; none of the patients dropped LVEF during exercise. Multivariate analysis revealed no significant predictors of LVEF response to exercise. However, there was a tendency that resting LVEF and enddiastolic volume index with exercise might influence LVEF response to exercise. Peak left ventricular ejection rate (LVER) at rest averaged 3.3s–1 ± 0.6 SD and increased to 51 s–1 ± 11 SD (P<0.005) with exercise. Peak left ventricular early filling rate (LVFR) was 2.8s–1 ± 0.6 SD at rest and was measured 5.5 s–1 ± l.3 SD at maximum exercise (P<0.005). Left ventricular enddiastolic volume (EDV) did not change significantly from rest to maximum exercise, whereas left ventricular endsystolic volume (ESV) decreased to 79% ± 19 SD (P<0.01) of the value at rest.

In conclusion, in a normal population other than healthy young volunteers LVEF does not necessarily have to increase with exercise. Moreover, besides an augmentation of heart rate a normal left ventricular response to supine exercise is associated with an increase of LVER and LVFR, a decrease in ESV and no significant change in EDV, suggesting augmented contractility and a virtually negligible role of the Frank-Starling mechanism during exercise.

Key Words: Normal ejection fraction response to exercise • radionuclide ventriculography • normal left ventricular function


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