Document Detail


Size, shape, and stamina: the impact of left ventricular geometry on exercise capacity.
MedLine Citation:
PMID:  20215563     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Although several studies have examined the cardiac functional determinants of exercise capacity, few have investigated the effects of structural remodeling. The current study evaluated the association between cardiac geometry and exercise capacity. Subjects with ejection fraction > or = 50% and no valvular disease, myocardial ischemia, or arrhythmias were identified from a large prospective exercise echocardiography database. Left ventricular mass index and relative wall thickness were used to classify geometry into normal, concentric remodeling, eccentric hypertrophy, and concentric hypertrophy. All of the subjects underwent symptom-limited treadmill exercise according to standard Bruce protocol. Maximal exercise tolerance was measured in metabolic equivalents. Of 366 (60+/-14 years; 57% male) subjects, 166 (45%) had normal geometry, 106 (29%) had concentric remodeling, 40 (11%) had eccentric hypertrophy, and 54 (15%) had concentric hypertrophy. Geometry was related to exercise capacity: in descending order, the maximum achieved metabolic equivalents were 9.9+/-2.8 in normal, 8.9+/-2.6 in concentric remodeling, 8.6+/-3.1 in eccentric hypertrophy, and 8.0+/-2.7 in concentric hypertrophy (all P<0.02 versus normal). Left ventricular mass index and relative wall thickness were negatively correlated with exercise tolerance in metabolic equivalents (r=-0.14; P=0.009 and r=-0.21; P<0.001, respectively). Augmentation of heart rate and ejection fraction with exercise were blunted in concentric hypertrophy compared with normal, even after adjusting for medications. In conclusion, the pattern of ventricular remodeling is related to exercise capacity among low-risk adults. Subjects with concentric hypertrophy display the greatest limitation, and this is related to reduced systolic and chronotropic reserve. Reverse remodeling strategies may prevent or treat functional decline in patients with structural heart disease.
Authors:
Carolyn S P Lam; Jasmine Grewal; Barry A Borlaug; Steve R Ommen; Garvan C Kane; Robert B McCully; Patricia A Pellikka
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-03-09
Journal Detail:
Title:  Hypertension     Volume:  55     ISSN:  1524-4563     ISO Abbreviation:  Hypertension     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-15     Completed Date:  2010-05-28     Revised Date:  2011-05-13    
Medline Journal Info:
Nlm Unique ID:  7906255     Medline TA:  Hypertension     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1143-9     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure / physiology
Cardiomegaly / physiopathology
Dyspnea
Echocardiography / methods
Echocardiography, Transesophageal
Exercise Test
Fatigue
Female
Heart Rate / physiology
Heart Ventricles / anatomy & histology*,  physiopathology,  ultrasonography
Humans
Male
Middle Aged
Organ Size
Patient Selection
Stroke Volume
Ventricular Remodeling / physiology*
Grant Support
ID/Acronym/Agency:
1 UL1 RR024150-01/RR/NCRR NIH HHS; UL1 RR024150-04/RR/NCRR NIH HHS
Comments/Corrections

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