Effects of age on ventricular performance during graded supine exercise

Mann, Douglas L.; Denenberg, Barry; Gash, Arnold K.; Makler, P.T.; Bové, Alfred A.

doi:10.1016/0002-8703(86)90561-2

Cited by 35 publications

(12 citation statements)

References 28 publications

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“…LV and RV EDV did not increase during exercise; RV EDV actually decreased slightly at the highest Hence, in the absence of an increase in EDV, the improvement in SV is most likely a reflection of increased contractility rather than a result of the FrankStarling mechanism and more favorable muscle fiber stretch. These results are in keeping with previous reports of studies using radionuclide (17)(18)(19) and MRI (7) techniques and describe the physiological response to exercise seen in young adults (20). Therefore, we believe that the described exercise protocol represents effective and physiological modality for cardiac stress testing.…”

Section: Physiological Response To Exercisesupporting

confidence: 91%

Feasibility and reproducibility of biventricular volumetric assessment of cardiac function during exercise using real‐time radial k‐t SENSE magnetic resonance imaging

Lurz

Muthurangu

Schievano

et al. 2009

Magnetic Resonance Imaging

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Purpose:To assess the feasibility and reproducibility of real-time radial k-t sensitivity encoding (SENSE) magnetic resonance imaging (MRI) for biventricular volumetric assessment during exercise. Materials and Methods:In all, 12 healthy young adults underwent MRI at rest and during supine exercise at three different workload intensities. Biventricular volumes and function were assessed with 1) a radial k-t SENSE real-time sequence and 2) a scanner vendor supplied (standard) realtime sequence. Global image quality, motion fidelity, and agreement in right ventricular (RV) and left ventricular (LV) stroke volume (SV) as a surrogate measure for accuracy were assessed. Exercise MR was repeated within 1 month for assessment of reproducibility.Results: Imaging scores were superior for radial real-time k-t SENSE images (P Ͻ 0.001). Agreement in RV and LV SV during exercise was better with radial k-t real-time (SD of difference Ϯ3.43 vs. Ϯ8.97 mL; P Ͻ 0.001). Agreement in cardiac output (CO) in the same subject at two different imaging sessions was better for radial k-t SENSE. This was significant for the CO calculated for the RV (SD of difference Ϯ0.6 vs. Ϯ0.95 L/min; P ϭ 0.01) and LV (Ϯ0.45 vs. Ϯ0.92 L/min; P Ͻ 0.001). Conclusion:Radial k-t SENSE real-time imaging represents a feasible and reproducible imaging technique for biventricular assessment during exercise.

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Section: Physiological Response To Exercisesupporting

confidence: 91%

Feasibility and reproducibility of biventricular volumetric assessment of cardiac function during exercise using real‐time radial k‐t SENSE magnetic resonance imaging

Lurz

Muthurangu

Schievano

et al. 2009

Magnetic Resonance Imaging

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“…Our study does not address these specific mechanisms, but previous reports suggest that aging is associated with an increased reliance on the Frank-Starling mechanism to maintain CO during maximal exercise. 6,33,32,35,38 However, not all reports support this concept, and it remains unclear if the Frank-Starling adaptation can be sustained throughout older age. Several plausible mechanisms have been described that could account for the improvements observed in AVDO 2max .…”

Section: Mechanisms Of Adaptationmentioning

confidence: 99%

A 30-Year Follow-Up of the Dallas Bed Rest and Training Study

et al. 2001

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Background-Aerobic power declines with age. The degree to which this decline is reversible remains unclear. In a 30-year longitudinal follow-up study, the cardiovascular adaptations to exercise training in 5 middle-aged men previously trained in 1966 were evaluated to assess the degree to which the age-associated decline in aerobic power is attributable to deconditioning and to gain insight into the specific mechanisms involved. Methods and Results-The cardiovascular response to acute submaximal and maximal exercise were assessed before and after a 6-month endurance training program. On average, V O 2max increased 14% (2.9 versus 3.3 L/min), achieving the level observed at the baseline evaluations 30 years before. Likewise, V O 2max increased 16% when indexed to total body mass (31 versus 36 mL/kg per minute) or fat-free mass (44 versus 51 mL/kg fat-free mass per minute). Maximal heart rate declined (181 versus 171 beats/min) and maximal stroke volume increased (121 versus 129 mL) after training, with no change in maximal cardiac output (21.4 versus 21.7 L/min); submaximal heart rates also declined to a similar degree. Maximal AVDO 2 increased by 10% (13.8 versus 15.2 vol%) and accounted for the entire improvement of aerobic power associated with training. Conclusions-One hundred percent of the age-related decline in aerobic power among these 5 middle-aged men occurring over 30 years was reversed by a 6-month endurance training program. However, no subject achieved the same maximal V O 2 attained after training 30 years earlier, despite a similar relative training load. The improved aerobic power after training was primarily the result of peripheral adaptation, with no effective improvement in maximal oxygen delivery.

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“…Reduced rate and extent of left ventricular filling, in turn, may influence systolic performance during exercise, as left ventricular stroke volume and ejection fraction are augmented during supine exercise in many normal subjects (especially those in middle or old age) through left ventricular chamber dilatation. [33][34][35] Impaired left ventricular filling and restriction of left ventricular dilatation during exercise will limit this physiologic response.…”

Section: Echocardiographic Datamentioning

confidence: 99%

Left ventricular hypertrophy and impaired diastolic filling in essential hypertension. Diastolic mechanisms for systolic dysfunction during exercise.

et al. 1990

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Left ventricular ejection fraction is normal at rest but may respond abnormally to exercise in many patients with essential hypertension. To assess the determinants of the abnormal ejection fraction response to exercise, we performed radionuclide angiography at rest and during exercise in 41 hypertensive patients without coronary artery disease. In 22 patients (group 1), the ejection fraction increased more than 5% during exercise; in the other 19 patients (group 2), the ejection fraction either increased by less than 5% or decreased with exercise. Left ventricular diastolic filling was impaired at rest in patients in group 2 compared with group 1, with reduced peak filling rate (2.5±0.4 vs. 3.1±0.7 end-diastolic volume/sec; p<0.01) and prolonged time to peak filling rate (175±28 vs. 153+±22 msec; p<0.01). Impaired diastolic filling in group 2 was associated with less augmentation in end-diastolic volume during exercise compared with group 1 (p <0.01). These observations were not dependent on the threshold value that was arbitrarily chosen to define an abnormal ejection fraction response, as there were significant correlations for the entire group between the magnitude of change in ejection fraction with exercise and both the resting peak filling rate (r=0.46) and the change in end-diastolic volume with exercise (r=0.62). Echocardiographic left ventricular mass index was greater in group 2 than in group 1 (141±32 vs. 114+±25 g/m2;p<0.01), and for the entire group was significantly related to peak filling rate (r= -0.50) and time to peak filling rate (r= 0.53). Thus, the abnormal ejection fraction response to exercise in patients with hypertension is related to greater left ventricular mass index and impaired diastolic filling, leading to inadequate augmentation of end-diastolic volume during exercise to maintain systolic function. These findings support the concept that exercise-induced systolic dysfunction in hypertensive patients with left ventricular hypertrophy arises predominantly from diastolic mechanisms. (Circulation 1990;81:978-986

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Effects of age on ventricular performance during graded supine exercise

Cited by 35 publications

References 28 publications

Feasibility and reproducibility of biventricular volumetric assessment of cardiac function during exercise using real‐time radial k‐t SENSE magnetic resonance imaging

Feasibility and reproducibility of biventricular volumetric assessment of cardiac function during exercise using real‐time radial k‐t SENSE magnetic resonance imaging

A 30-Year Follow-Up of the Dallas Bed Rest and Training Study

Left ventricular hypertrophy and impaired diastolic filling in essential hypertension. Diastolic mechanisms for systolic dysfunction during exercise.

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