Document Detail

Exercise testing in asymptomatic or minimally symptomatic aortic regurgitation: relationship of left ventricular ejection fraction to left ventricular filling pressure during exercise.
MedLine Citation:
PMID:  6299613     Owner:  NLM     Status:  MEDLINE    
Exercise radionuclide angiography is being used to evaluate left ventricular function in patients with aortic regurgitation. Ejection fraction is the most common variable analyzed. To better understand the rest and exercise ejection fraction in this setting, 20 patients with asymptomatic or minimally symptomatic severe aortic regurgitation were studied. All underwent simultaneous supine exercise radionuclide angiography and pulmonary gas exchange measurement and underwent rest and exercise measurement of pulmonary artery wedge pressure (PAWP) during cardiac catheterization. Eight patients had a peak exercise PAWP less than 15 mm Hg (group 1) and 12 had a peak exercise PAWP greater than or equal to 15 mm Hg (group 2). Group 1 patients were younger and more were in New York Heart Association class I. Group 1 patients also had a higher mean rest ejection fraction (0.64 +/- 0.08 vs 0.49 +/- 0.13, p less than 0.01, higher exercise ejection fraction (0.63 +/- 0.10 vs 0.40 +/- 0.18, p less than 0.01), lower end-systolic volume (38 +/- 13 vs 79 +/- 36 ml/m2, p less than 0.01) and higher peak oxygen uptake (24.9 +/- 5.1 vs 16.6 +/- 4.9 ml/kg/min, p less than 0.01) than group 2 patients. However, the two groups had similar cardiothoracic ratios, changes in ejection fractions with exercise, and rest and exercise regurgitant indexes. Using multiple regression analysis, the best correlate of the exercise PAWP was peak oxygen uptake (r = -0.78, p less than 0.01). No other measurement added significantly to the regression. When peak oxygen uptake was excluded, rest and exercise ejection fraction also correlated significantly (r = -0.62 and r = -0.60, respectively, p less than 0.01). Patients with asymptomatic or minimally symptomatic severe aortic regurgitation have a wide spectrum of cardiac performance in terms of the PAWP during exercise. The absolute rest and exercise ejection fraction and the level of exercise achieved are noninvasive variables that correlate with exercise PAWP in aortic regurgitation, but the change in ejection fraction with exercise by itself is not.
C A Boucher; R A Wilson; D J Kanarek; A M Hutter; R D Okada; R R Liberthson; H W Strauss; G M Pohost
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Circulation     Volume:  67     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1983 May 
Date Detail:
Created Date:  1983-05-27     Completed Date:  1983-05-27     Revised Date:  2007-11-14    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1091-100     Citation Subset:  AIM; IM    
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MeSH Terms
Age Factors
Aortic Valve Insufficiency / physiopathology*,  radionuclide imaging
Cardiac Output*
Exercise Test*
Heart Catheterization
Heart Rate
Heart Ventricles / physiopathology*,  radionuclide imaging
Middle Aged
Oxygen Consumption
Pulmonary Gas Exchange
Pulmonary Wedge Pressure
Regression Analysis
Sodium Pertechnetate Tc 99m
Stroke Volume*
Technetium / diagnostic use
Grant Support
Reg. No./Substance:
23288-60-0/Sodium Pertechnetate Tc 99m; 7440-26-8/Technetium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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