Left Ventricular Performance During Muscular Exercise in Patients with and without Cardiac Dysfunction

Abstract

The LVEDP, cardiac output, and V o o2 were measured before and during supine muscular exercise in 38 patients. The normal pattern, established in seven patients without left ventricular dysfunction, consisted of an exercise factor [see Equation in PDF File], an LVEDP during exercise of less than 12 mm Hg, and little change or a decrease in LVEDP, which was accompanied in most instances by an increase in the stroke volume. In the majority of 31 patients with various cardiac lesions, but without valvular regurgitation, measurement of the LVEDP before and during exercise permitted the definition of normal or abnormal left ventricular function when the status of the left ventricle could not have been ascertained from other measurements. Thus, in most of the patients with mitral stenosis and abnormal resting hemodynamics, the pattern of left ventricular function during exercise was considered to be normal. Among the patients with aortic stenosis or left ventricular myocardial disease and elevated resting LVEDP, two types of abnormal performance of the left ventricle were identified. In some patients, an increase in LVEDP was accompanied by an increase in stroke volume, and this response was termed "abnormal left ventricular dynamics"; in the remaining patients, an increase in LVEDP and no change or a fall in stroke volume occurred and this response was termed "depressed left ventricular function." It is concluded that determination of the LVEDP before and during exercise adds importantly to measurements of the changes in cardiac output and O 2 consumption in characterizing left ventricular performance. The method employs standard catheterization techniques and appears to provide a practical and useful means for evaluating the functional status of the left ventricle in patients with and without myocardial dysfunction.