Author + information
- Received August 13, 1984
- Revision received October 24, 1984
- Accepted November 5, 1984
- Published online April 1, 1985.
- Barry M. Bassie, MD, FACC1,*,†,
- Barry L. Kramer, MD*,†,
- Debra Loge, BS*,†,
- Nina Topic, RN*,†,
- Barry H. Greenberg, MD, FACC‡,
- Melvin D. Cheitlin, MD, FACC†,
- J. David Bristow, MD, FACC‡ and
- Randolph C. Byrd, MD†
- ↵1Address for reprints: Barry Massie, MD, Cardiology Service (111C), Veterans Administration Hospital, 4150 Clement Street, San Francisco, California 94121.
The change in ejection fraction during exercise is frequently employed as a measure of left ventricular functional reserve in patients with aortic regurgitation. However, little information is available about its relation to invasive measurements of cardiac performance. Therefore, simultaneous hemodynamic measurements and supine exercise blood pool scintigraphy were performed in 14 patients with severe, asymptomatic or minimally symptomatic aortic regurgitation associated with cardiomegaly but preserved left ventricular function at rest. Their hemodynamic measurements at rest were normal and their exercise capacity was excellent.
When the patients were categorized into those patients whose ejection fraction increased or did not decrease by more than 0.05 (Group 1) and those whose ejection fraction decreased by more than 0.05 (Group 2), important differences were apparent. Echocardio-graphic, radionuclide and hemodynamic measurements at rest in the two patient groups were similar, but Group 1 exhibited a greater increase in cardiac index during supine exercise (2.8 ± 0.4 to 10.0 ± 1.8 versus 2.7 ± 0.5 to 6.9 ± 1.0 liters/min per m2; p < 0.005) and a lesser increase in pulmonary capillary wedge pressure (13 ± 4 to 19 ± 7 versus 12 ± 4 to 31 ± 8 mm Hg; p < 0.01). The severity of regurgitation decreased during exercise in all patients, but end-diastolic volume decreased and end-systolic volume decreased or was unchanged in Group 1, whereas end-diastolic volume was unchanged and end-systolic volume increased in Group 2. In the patient group as a whole, the change in ejection fraction correlated closely with the exercise-induced increase in cardiac index (r = 0.81, p < 0.001) and significantly, though less closely and in an inverse manner, with the increase in pulmonary capillary wedge pressure (r = −0.69, p < 0.01). Thus, the exercise ejection fraction response during supine exercise is a useful indicator of left ventricular reserve in aortic regurgitation and correlates well with invasive exercise hemodynamic measurements.
- Received August 13, 1984.
- Revision received October 24, 1984.
- Accepted November 5, 1984.
- American College of Cardiology Foundation