Differences in myocardial velocities during supine and upright exercise stress echocardiography in healthy adults.
ABSTRACT Tissue Velocity Imaging (TVI) is a method for quantitative analysis of longitudinal myocardial velocities, which can be used during exercise and pharmacological stress echocardiography. It is of interest to evaluate cardiac response to different types of stress tests and the differences between upright and supine bicycle exercise tests have not been fully investigated. Therefore, the aim of this study was to compare cardiac response during supine and upright exercise stress tests.
Twenty young healthy individuals underwent supine and upright stress test. The initial workload was set to 30 W and was increased every minute by a further 30 W until physical exhaustion. Tissue Doppler data from the left ventricle were acquired at the end of every workload level using a GE Vivid7 Dimension system (>200 frames s(-1)). In the off-line processing, isovolumic contraction velocity (IVCV), peak systolic velocity (PSV), isovolumic relaxation velocity (IVRV), peak early diastolic velocity (E') and peak late diastolic velocity (A') were identified at every workload level.
No significant difference between the tests was found in PSV. On the contrary, E' was shown to be significantly higher (P<0.001) during supine exercise than during upright exercise and IVRV was significantly lower (P<0.001) during supine exercise compared to upright exercise.
Upright and supine exercise stress echocardiography give a comparable increase in measured systolic velocities and significant differences in early diastolic velocities.
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ABSTRACT: Assessment of myocardial contractile function during exercise is important in gaining an understanding of the normal mechanics of the cardiovascular responses to exercise stress. Such insights are important in identifying determinants of cardiovascular fitness in athletes as well as assessing patients with heart disease. While obtaining such measurements in the past has been challenging, recent echocardiographic developments offer promise of providing new insights into the nature and magnitude of inotropic changes during exercise. This review provides a state-of-the-art overview of these technologies in light of the current understanding of the role of myocardial contractile function in response to a bout of progressive dynamic exercise.Current Sports Medicine Reports 03/2013; 12(2):93-100. · 1.51 Impact Factor
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ABSTRACT: Orthostatic-induced alterations in Doppler echocardiographic measures of ventricular function have not been well-defined. Identifying such changes may provide useful insights regarding the responses of these measures to variations in ventricular loading conditions. Standard assessment of mitral inflow velocity and tissue Doppler imaging (TDI) of left ventricular longitudinal myocardial velocities was performed on 14 young males (mean age 17.9 ± 0.7 years) in the supine position and then 5 minutes after assuming a sitting position with legs dependent. Upon sitting, average values of stroke volume and cardiac output fell by 28% and 18%, respectively, while heart rate increased from 64 ± 10 to 73 ± 12 beats/min (+14%) and calculated systemic vascular resistance rose from 12.9 ± 2.2 to 16.4 ± 3.1 units (+27%). Mitral E peak velocity declined from 87 ± 16 to 64 ± 16 cm/sec, and average TDI-E' and TDI-S both decreased (by -44% and -20%, respectively). When adjusted for orthostatic decreases in left ventricular end-diastolic volume, the mean decrease in TDI-E' was reduced to -29 (P < 0.01), but no significant decline was observed in adjusted TDI-S. Average E/E' rose with sitting by 40% (P = 0.02). These findings suggest that (a) decreases in TDI measures when assuming the upright position reflect the reduction of left ventricular size; (b) orthostatic fall in TDI-E' is also related to smaller ventricular size but, in addition, to a nonspecified reduction in ventricular relaxation; and (c) values of E/E' do not reflect alterations in ventricular preload, which occur during an orthostatic challenge.Echocardiography 02/2012; 29(5):523-7. · 1.26 Impact Factor