Clinical study
Alterations in left ventricular volumes and ejection fraction at rest and during exercise in patients with aortic regurgitation

https://doi.org/10.1016/0002-9149(81)90567-1Get rights and content

Abstract

This study was performed (1) to determine the changes in left ventricular volumes during exercise in patients with aortic regurgitation, and (2) to evaluate the importance of these alterations in characterizing left ventricular function in these patients. In 15 normal subjects (Group I) and in 17 patients with aortic regurgitation (Group II), left ventricular end-diastolic volume index, end-systolic volume index, ejection fraction and the ratio of peak systolic blood pressure to end-systolic volume index were measured at rest and during supine exercise. The patients with aortic regurgitation were classified into two groups on the basis of symptoms and chest radiographs: Group IIA, minimal or no symptoms, no cardiomegaly or pulmonary venous congestion; Group IIB, definite symptoms, with cardiomegaly and pulmonary venous congestion. Patients with aortic regurgitation had greater left ventricular end-diastolic and end-systolic volume indexes at rest and during exercise (p <0.05) than did normal subjects. During exercise, left ventricular end-diastolic volume index increased in normal subjects (53 ± 13 ml/m2 [mean ± standard deviation] at rest, 67 ± 18 ml/m2 during exercise, p <0.01), demonstrated a heterogeneous response in patients in Group IIA and increased in patients in Group IIB (180 ± 96 ml/m2 at rest, 209 ± 102 ml/m2 during exercise, p <0.05). During exercise, left ventricular end-systolic volume index decreased in normal subjects (18 ± 5 ml/m2 at rest, 15 $̄6 ml/m2 with exercise, p <0.01), increased in patients in Group IIB (82 ± 60 ml/m2 at rest, 118 ± 93 ml/m2 during exercise, p <0.05), and showed a variable response in those in Group IIA. At rest, left ventricular ejection fraction was similar in the three groups, but during exercise it increased in Group I (0.71 ± 0.07 at rest, 0.82 ± 0.07 with exercise, p <0.001), was unchanged in Group IIA and decreased in Group IIB (0.59 ± 0.15 at rest, 0.50 ± 0.16 during exercise, p <0.05). During exercise, there was an inverse relation between changes in left ventricular ejection fraction and endsystolic volume, but no relation between changes in end-diastolic volume and ejection fraction. Changes in the systolic pressure-volume ratio provided no more information than changes in end-systolic volume alone. Thus, abnormal alterations in left ventricular volumes occur during exercise in patients with aortic regurgitation and may be helpful in the further characterization of left ventricular performance in these patients.

References (50)

  • EF Blank et al.

    Severe aortic regurgitation in young people

    N Engl J Med

    (1957)
  • M Spagnuolo et al.

    Natural history of rheumatic aortic regurgitation. Criteria predictive of death, congestive heart failure, and angina in young patients

    Circulation

    (1971)
  • A Haravon et al.

    Aortic insufficiency. Clinical course under medical therapy

    NY J Med

    (1969)
  • N Goldschiager et al.

    Natural history of aortic regurgitation. A clinical and hemodynamic study

    Am J Med

    (1973)
  • MJ Tyrell et al.

    Correlation of degree of left ventricular volume overload with clinical course in aortic and mitral regurgitation

    Br Heart J

    (1976)
  • JH Mitchell et al.

    Analysis of left ventricular function

  • JP Holt

    Regulation of the degree of emptying of the left ventricle by the force of ventricular contraction

    Circ Res

    (1957)
  • W Grossman et al.

    Contractile state of the left ventricle in man as evaluated from end-systolic pressure-volume relations

    Circulation

    (1977)
  • WL Henry et al.

    Observations on the optimum time for operative intervention for aortic regurgitation. I. Evaluation of the results of aortic valve replacement in symptomatic patients

    Circulation

    (1980)
  • WL Henry et al.

    Observations on the optimum time for operative intervention for aortic regurgitation. II. Serial echocardiographic evaluation of asymptomatic patients

    Circulation

    (1980)
  • CL Curiha et al.

    Preoperative M-mode echocardiography as a predictor of surgical results in chronic aortic insufficiency

    J Thorac Cardiovasc Surg

    (1980)
  • AM Abdulla et al.

    Limitations of echocardiography in the assessment of left ventricular size and function in aortic regurgitation

    Circulation

    (1979)
  • AD Johnson et al.

    Assessment of left ventricular function in severe aortic regurgitation

    Circulation

    (1976)
  • DR Bhatt et al.

    Accuracy of echocardiography in assessing left ventricular dimensions and volume

    Circulation

    (1978)
  • RA O'Rourke et al.

    Timing of valve replacement in patients with chronic aortic regurgitation (editorial)

    Circulation

    (1980)
  • Cited by (0)

    This work was supported by Ischemic SCOR Grant HL-17669 from the National Institutes of Health, Bethesda, Maryland and the Harry S. Moss Heart Fund, Dallas, Texas.

    View full text