Summary
Percutaneous transvenous mitral commissurotomy (PTMC) increases peak oxygen uptake (VO2) chronically, but not acutely, despite early symptomatic improvements. Analysis of transient VO2 responses to submaximal exercise (an exercise regimen more comparable to the patients’ daily activities than that provided by maximal exercise testing), may be sensitive in detecting the acute hemodynamic benefits of PTMC. Since no methods are available to accurately estimate the transient response of VO2, we developed a new technique, using random exercise. In 15 patients who underwent successful PTMC, we repeated the conventional maximal exercise test and the random exercise test before and within a few days after PTMC. For the random exercise test, we intermittently imposed upright bicycle exercise at 50 W, according to a random binary sequence, while measuring breath-by-breath VO2. After determining the transfer function relating work-load to VO2, we computed the high resolution VO2 response to a hypothetical step increase in exercise. Despite improvements in resting hemodynamics and New York Heart Association (NYHA) Class, peak VO2 improved insignificantly (952±271 vs 1,029±342 ml/min,P=0.063) shortly after successful PTMC. In contrast, the amplitude of the VO2 step response increased significantly in the early-to-mid portion (28–76s;P<0.01–0.05). The remaining portion was unchanged. Consequently, the time constant shortened from 64±26 to 48±22 s (P<0.05). The maximal Borg scale value during random exercise decreased significantly (13.1±1.8 vs 11.4±1.1;P<0.01). We conclude that the VO2 step response, using the random exercise test, is more sensitive than peak VO2 in detecting the functional improvement that is coupled with the hemodynamic improvement immediately after PTMC.
Similar content being viewed by others
References
Marzo KP, Herrmann HC, Mancini DM (1993) Effect of balloon mitral valvuloplasty on exercise capacity, ventilation and skeletal muscle oxygenation. JACC 21:856–865
Chen CR, Cheng TO, Chen JY, Zhou YL, Mei J, Ma TZ (1992) Long-term results of percutaneous mitral valvuloplasty with the Inoue balloon catheter. Am J Cardiol 70:1445–1448
Tanabe Y, Suzuki M, Takahashi M, Oshima M, Yamazaki Y, Yamaguchi T, Igarashi Y, Tamura Y, Yamazoe M, Shibata A (1993) Acute effect of percutaneous transvenous mitral commissurotomy on ventilatory and hemodynamic responses to exercise. Pathophysiological basis for early symptomatic improvement. Circulation 88:1770–1778
Martinez EE, Barros TL, Santos DV, Carvalho AC, Paola AA, Andrade JL, Angellini J, Lima VC, Roverti RR, Portugal OP, Sherman W (1992) Cardiopulmonary exercise testing early after catheter-balloon mitral valvuloplasty in patients with mitral stenosis. Int J Cardiol 37:7–13
Le Jemtel TH, Maskin CS, Lucido D, Chadwick BJ (1986) Failure to augment maximal limb flow in response to one-leg versus two-leg exercise in patients with severe heart failure. Circulation 74:245–251
Sullivan MJ, Green HJ, Cobb FR (1990) Skeletal muscle biochemistry and histology in ambulatory patients with long-term heart failure. Circulation 81:518–557
Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N (1984) Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg 87:394–402
Marmarelis PZ, Marmarelis VZ (1978) Analysis of physiological systems. Plenum, New York
Borg G (1970) Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med 2:92–98
Harris FJ (1978) On the use of windows for harmonic analysis with the discrete Fourier transform. Proc IEEE 66:51–83
Drexler H, Banhardt U, Meinertz T, Wollschlager H, Lehmann M, Just H (1989) Contrasting peripheral short-term and long-term effects of converting enzyme inhibition in patients with congestive heart failure. A double-blind, placebo-controlled trial. Circulation 79:491–502
Lipkin DP, Frenneaux M, Stewart R, Joshi J, Lowe T, McKenna WJ (1988) Delayed improvement in exercise capacity after cardioversion of atrial fibrillation to sinus rhythm. Br Heart J 59:572–577
Koike A, Hiroe M, Adachi H, Yajima T, Yamauchi Y, Nogami A, Ito H, Miyahara Y, Korenaga M, Marumo F (1994) Oxygen uptake kinetics are determined by cardiac function at onset of exercise rather than peak exercise in patients with prior myocardial infarction. Circulation 90:2324–2332
Sietsema KE, Ben-Doy I, Zhang YY, Sullivan C, Wasserman K (1994) Dynamics of oxygen uptake for submaximal exercise and recovery in patients with chronic heart failure. Chest 105:1693–1700
Hiroshi Takaki, Kenji Sunagawa (1994) Abnormal transient response of VO2 to exercise in patients with heart failure. Random noise approach (abstract). Circulation 90(No. 4, Part 2):I-6
Tamai J, Nagata S, Akaike M, Ishikura F, Kimura K, Takamiya M, Miyatake K, Nimura Y (1990) Improvement in mitral flow dynamics during exercise after percutaneous transvenous mitral commissurotomy. Noninvasive evaluation using continuous wave Doppler technique. Circulation 81:46–51
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Takaki, H., Kenji-Sunagawa, Sugimachi, M. et al. Percutaneous transvenous mitral commissurotomy immediately restores quick response of VO2 to mild exercise despite insignificant increases in peak VO2 . Heart Vessels 10, 323–327 (1995). https://doi.org/10.1007/BF02911391
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02911391