Mechanisms of Exercise Intolerance

Skaluba, Stanislaw J.; Litwin, Sheldon E.

doi:10.1161/01.cir.0000117405.74491.d2

Cited by 167 publications

(46 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[18][19][20] In this study, the rate of increase in E' between rest and exercise was strongly correlated with exercise tolerance. There are two reasons that exercise tolerance with impairment of LVDF can be reduced.…”

Section: Exercise and Left Ventricular Diastolic Functionmentioning

confidence: 53%

Effect of Changes in Left Ventricular Diastolic Function During Exercise on Exercise Tolerance Assessed by Exercise-Stress Tissue Doppler Echocardiography

et al. 2009

View full text Add to dashboard Cite

SummaryCardiac function during exercise is assumed to be important in determining exercise tolerance. The aims of this study were to evaluate changes in left ventricular diastolic function (LVDF) during exercise and its effect on exercise tolerance assessed by a noninvasive method, exercise-stress tissue Doppler echocardiography. Twenty-six men with sinus rhythm (controls, hypertension, and cardiomyopathy) underwent cardiopulmonary exercise testing. To assess LVDF during exercise, exercise-stress Doppler echocardiography was performed with a constant workload at rest, and at 50%, 100%, and 120% of anaerobic threshold (AT). Doppler variables related to LVDF increased significantly as the workload increased (P < 0.05). Resting E' correlated significantly with AT (r = 0.424, P = 0.0308) and peak V 4 O 2 (r = 0.471, P = 0.0152). However, the difference in E' between rest and 120% AT (∆E') was closely correlated with AT (r = 0.744, P < 0.0001) and peak V 4 O 2 (r = 0.748, P < 0.0001). Moreover, ∆E' was correlated independently with AT (P = 0.0321) and peak V 1) However, the correlation between objective measurements of exercise tolerance and systolic left ventricular function is poor.2) It is clear that left ventricular diastolic function (LVDF) is an important determinant of exercise tolerance in normal individuals and in patients with various cardiac diseases. Recently, several studies have shown correlationsFrom the

show abstract

Section: Exercise and Left Ventricular Diastolic Functionmentioning

confidence: 53%

Effect of Changes in Left Ventricular Diastolic Function During Exercise on Exercise Tolerance Assessed by Exercise-Stress Tissue Doppler Echocardiography

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Furthermore, Doppler tissue imaging has shown that the Doppler E-wave maximumto-mitral annular velocity maximum ratio and exercise capacity demonstrate a strong negative correlation. The Doppler E-wave maximum-to-mitral annular velocity maximum ratio has not only been observed to be highly correlated with LVEDP or pulmonary capillary wedge pressure but also has been shown to be a causal determinant of LVEDP as a consequence of the "constant-volume" property of the two-chambered heart (20,25,30).…”

Section: Discussionmentioning

confidence: 99%

Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction

Meyer¹,

Karamanoglu²,

Kovács

2004

Journal of Applied Physiology

View full text Add to dashboard Cite

. Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction. J Appl Physiol 97: 1667-1672. First published June 18, 2004 doi:10.1152/japplphysiol.00078.2004.-Impaired exercise tolerance, determined by peak oxygen consumption (V O2 peak), is predictive of mortality and the necessity for cardiac transplantation in patients with chronic heart failure (HF). However, the role of left ventricular (LV) diastolic function at rest, reflected by chamber stiffness assessed echocardiographically, as a determinant of exercise tolerance is unknown. Increased LV chamber stiffness and limitation of V O2 peak are known correlates of HF. Yet, the relationship between chamber stiffness and V O2 peak in subjects with HF has not been fully determined. Forty-one patients with HF New York Heart Association [(NYHA) class 2.4 Ϯ 0.8, mean Ϯ SD] had echocardiographic studies and V O2 peak measurements. Transmitral Doppler E waves were analyzed using a previously validated method to determine k, the LV chamber stiffness parameter. Multiple linear regression analysis of V O2 peak variance indicated that LV chamber stiffness k (r 2 ϭ 0.55) and NYHA classification (r 2 ϭ 0.43) were its best independent predictors and when taken together account for 59% of the variability in V O2 peak. We conclude that diastolic function at rest, as manifested by chamber stiffness, is a major determinant of maximal exercise capacity in HF. diastole; echocardiography; oxygen consumption CHRONIC HEART FAILURE (HF) is a major health problem that carries a high mortality rate despite continued significant advances in medical therapy. With ϳ400,000 new cases of HF diagnosed each year, 4.7 million Americans suffer from this debilitating disease (1). It has been established that patients with HF have impaired exercise tolerance that is predictive of mortality and the need for cardiac transplantation (10). Characteristically, the failing heart demonstrates an inability to maintain an adequate cardiac output, first during effort and later also at rest. Cardiac decompensation ultimately leads to impaired exercise capacity, fatigue, and exertional dyspnea. Patients with HF thus may have a decreased left ventricular (LV) ejection fraction (LVEF), large end-diastolic volume, and impaired contractile reserve (33, 34). Ventricular dysfunction as quantitated by a decreased LVEF is the main manifestation of HF that ultimately results in circulatory failure. Advanced LV dysfunction is associated with a variety of neurohumoral, peripheral circulatory, skeletal muscle, and respiratory adaptations that determine the syndrome's overall clinical presentation and prognosis (33, 34). The known mechanisms that lead to HF are highly complex, involving chamber enlargement and remodeling and decreased LV contractile reserve (10). The factor common to all types of HF regardless of etiology is increased LV end-diastolic pressure (LVEDP), which compromises LV filling, diminishes stroke volume and cardiac outpu...

show abstract

“…Furthermore, compared to peak E, E’ is relatively preload independent as was evident in patients with DD with pseudonormalisation of E velocity in which E’ remained low during saline loading or after nitroglycerin 71 . E’ also correlates closely with τ, even in atrial fibrillation 89 , and with invasively measured LVEDP both at rest and during exercise 90 , 91 .…”

Section: E' Velocitymentioning

confidence: 97%

Echocardiographic evaluation of diastolic heart failure

Thomas

2010

Australas J Ultrason Med

View full text Add to dashboard Cite

Mechanisms of Exercise Intolerance

Cited by 167 publications

References 41 publications

Effect of Changes in Left Ventricular Diastolic Function During Exercise on Exercise Tolerance Assessed by Exercise-Stress Tissue Doppler Echocardiography

Effect of Changes in Left Ventricular Diastolic Function During Exercise on Exercise Tolerance Assessed by Exercise-Stress Tissue Doppler Echocardiography

Left ventricular chamber stiffness at rest as a determinant of exercise capacity in heart failure subjects with decreased ejection fraction

Echocardiographic evaluation of diastolic heart failure

Contact Info

Product

Resources

About