Ejection fraction response to upright exercise in hypertension: relation to loading conditions and to contractility

Wijns, William; Pouleur, H.; Robert, Annie; Nannan, Michel; Coster, Patrick M. De; Beckers, Christian; Detry, Jean-Marie R.

doi:10.1016/0167-5273(87)90031-3

Cited by 11 publications

(6 citation statements)

References 30 publications

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“…However, there are conflicting data regarding the relationships between left ventricular systolic dysfunction and left ventricular hypertrophy in hypertensive patients (Masaaki, Sasayama, Kawai, & Katoura, 1980). The systolic function during exercise of the hypertensive patients in the present study is in agreement with previous studies which suggest that systolic function during exercise is abnormal in a substantial percentage of hypertensive patients who do not have associated coronary artery disease (Melvin et al, 1987;Miller et al, 1987). The physiological basis for this abnormality has not been explored.…”

Section: Discussionsupporting

confidence: 91%

The Effects of Hypertension and Aging on Left Ventricular Function during Isometric Exercise

Sagiv¹,

Sagiv²,

Ben‐Sira³

et al. 1996

Journal of Aging and Physical Activity

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Hemodynamic and left ventricular systolic function were studied by Doppler echocardiography in 14 young and 15 older adult hypertensive patients and in 15 young and 12 older normotensive individuals. Measures were made at rest and during upright deadlift isometric exercise, at 30% of maximum voluntary contraction for 3 min. At rest, young and older hypertensive patients demonstrated impaired left ventricular systolic function compared to both old and young normotensive subjects. The impaired systolic function was associated with less augmentation in systolic indices during exercise compared with resting values in young and elderly hypertensive patients, and to a lesser degree in the normotensive elderly when compared with young normotensives. These data indicate that at rest, left ventricular systolic function may be compromised in hypertensive patients with left ventricular hypertrophy and, to a lesser extent, in the normotensive elderly. However, other factors in chronic hypertension may contribute to abnormal systolic function and override the effects of aging alone.

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Section: Discussionsupporting

confidence: 91%

The Effects of Hypertension and Aging on Left Ventricular Function during Isometric Exercise

Sagiv¹,

Sagiv²,

Ben‐Sira³

et al. 1996

Journal of Aging and Physical Activity

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“…The relationship between cardiac dysfunction and wall stress has been formerly recognized in different forms of cardiac disease, including HTN 18,30,33 and was corroborated by the strong inverse correlation found between fractional shortening and end-systolic stress. It is tempting to speculate that although coronary reserve impairment alone does not seem critical for cardiac decompensation, the imbalance between myocardial supply, represented by coronary reserve, and demand, represented by systolic wall stress, might perpetuate and/or aggravate cardiac dysfunction.…”

Section: Discussionmentioning

confidence: 72%

The imbalance between coronary reserve and wall stress explains the severity of ventricular dysfunction in hypertension

Frimm¹,

Pereira²,

Rodrigues

et al. 2005

Clinical Cardiology

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SummaryBackground: The pathophysiologic role of coronary reserve impairment in hypertensive cardiac dysfunction is still debated. Previously, we demonstrated that satisfactory coronary vasodilatation may coexist with ventricular systolic dysfunction. It is conceivable that coronary reserve might otherwise be inappropriate for enhanced myocardial oxygen demand and may thus affect cardiac performance negatively.Hypothesis: Myocardial supply-demand imbalance contributes to the severity of ventricular dysfunction in hypertension (HTN).Methods: Fractional shortening (%) and end-systolic stress (10 3 ·dyn·cm Ϫ2 ) were determined using echocardiography, and coronary reserve was calculated using transesophageal Doppler echocardiography. Coronary reserve/ stress (cm 2 ·dyn Ϫ1 ) was utilized as a measure of supply-demand. Groups NL (20 healthy subjects), HTN1 (15 patients, fractional shortening ≥ 30), HTN2 (19 patients, 20 ≤ fractional shortening < 30), and HTN3 (21 patients, fractional shortening < 20) were constituted.Results: Compared with NL and HTN1, groups HTN2 and HTN3 had significantly (p < 0.05) greater end-systolic stress (NL = 72 ± 16, HTN1 = 72 ± 23, HTN2 = 143 ± 32, HTN3 = 186 ± 70). Coronary reserve was impaired in HTN3 alone (NL = 3.5 ± 0.6, HTN1 = 3.4 ± 1.0, HTN2 = 3.1 ± 1.0, HTN3 = 2.6 ± 1.1), but coronary reserve/stress was reduced in both

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“…Several studies have shown that in mild to moderate hypertensive patients LV chamber performance is usually preserved at rest, but may be abnormal when evaluated during exercise tests in which a greater myocardial contractility is required to achieve an adequate increase in cardiac output (Blaufox et al 1981;Melin et al 1987;Miller et al 1987). Long-lasting exercise has been reported to determine an impairment of LV contractility even in young healthy untrained (Seals et al 1988;Vanoverschelde et al 1991) as well as trained (Niemela et al 1984) individuals.…”

Section: Discussionmentioning

confidence: 99%

Left ventricular contractile performance in the early stage of hypertension in humans

Palatini

Frigo

Visentin

et al. 2001

European Journal of Applied Physiology

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The aim of the present study was to assess how cardiac structural changes contribute to increasing left ventricular pump function during exercise in subjects with mild hypertension. In 23 young male subjects with mild hypertension and 12 male normotensive control subjects, left ventricular function was measured echocardiographically using the fractional shortening/ meridional stress relationship at rest and during longlasting exercise at the anaerobic threshold. Mean exercise duration and intensity were 61 (SEM 1.7) min and 71.3 (SEM 2.5)% VO2max (maximal oxygen uptake), respectively, in the hypertensive subjects, and 63 (SEM 1.5) min and 75.7 (SEM 2.2)% VO2max, respectively, in the normotensive subjects (all differences= n.s.). Left ventricular fractional shortening was measured both at the endocardium and at the midwall. In the hypertensive subjects the endocardial fractional shortening, predicted on the basis of the shortening/stress relationship in the normotensive controls, overestimated midwall fractional shortening throughout rest (P=0.04) and exercise (P=0.004). To study how an increase in left ventricular wall thickness contributed to increasing ejection performance during exercise, the hypertensive subjects were divided according to whether their relative wall thickness was less than 0.35 or equal to or greater than 0.35. Subjects with relative wall thicknesses equal to or greater than 0.35 had a depressed myocardial contractility at rest (P=0.0001). During exercise they increased their stroke volume and cardiac output adequately through an increase in ejection performance, while myocardial contractility remained subnormal (P < 0.0001). In conclusion, the present results indicated that in mildly hypertensive subjects an increased left ventricular wall thickness is crucial in preserving left ventricular pump function during exercise.

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Ejection fraction response to upright exercise in hypertension: relation to loading conditions and to contractility

Cited by 11 publications

References 30 publications

The Effects of Hypertension and Aging on Left Ventricular Function during Isometric Exercise

The Effects of Hypertension and Aging on Left Ventricular Function during Isometric Exercise

The imbalance between coronary reserve and wall stress explains the severity of ventricular dysfunction in hypertension

Left ventricular contractile performance in the early stage of hypertension in humans

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