Left and right ventricular function at rest and during bicycle exercise in the supine and sitting positions in normal subjects and patients with coronary artery disease

Manyari, Dante E.; Kostuk, William J.; Purves, Paul

doi:10.1016/s0002-9149(83)80008-3

Cited by 94 publications

(29 citation statements)

References 36 publications

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“…In our patients, the less than twofold rise in cardiac output falls substantially short of the normal three to fourfold increase (Poliner et al, 1980). A heart rate increase was the primary means of the increasing exercise cardiac output in our subjects, but the maximal heart rate achieved is subnormal for comparably aged normal subjects during supine exercise (Manyari and Kostuk, 1983). This has previously been noted (Goldstein et al, 1975) and may be due to a blunted sympathetic response associated with the chronic adrenergic hyperactivity in congestive heart failure.…”

Section: Discussionsupporting

confidence: 46%

“…As a result of both diastolic and systolic ventricular dilatation, the depressed LV ejection fraction did not change significantly with exercise. This contrasts with the characteristic increased ejection fraction response in normals (Manyari and Kostuk, 1983;Poliner ef al., 1980) and the decrease noted in ischemic heart disease (Schoelmeester et af., 1981). Despite insignificant changes in mean ejection fraction with exercise, individual subjects in our study demonstrated the variability of this response in IDC.…”

Section: Discussionmentioning

confidence: 90%

“…Instead of the normally unchanged or decreased end-systolic volume with exercise (Manyari and Kostuk, 1983;Poliner et al, 1980), IDC patients developed progressive end-systolic enlargement. LV end-diastolic volume also increased significantly, a pattern which may be abnormal (Manyari and Kostuk, 1983). As a result of both diastolic and systolic ventricular dilatation, the depressed LV ejection fraction did not change significantly with exercise.…”

Section: Discussionmentioning

confidence: 93%

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The exercise response in idiopathic dilated cardiomyopathy

Kirlin

Das

Zijnen

et al. 1984

Clinical Cardiology

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Summary:In order to more clearly define the exercise response of idiopathic dilated cardiomyopathy (IDC), 20 patients in this study with strictly defined IDC were evaluated with radionuclide ventriculography and invasive hemodynamic monitoring. Severe cardiovascular impairment was present at rest, and peak supine exercise produced progressive left ventricular (LV) dilatation in both diastole and systole (meanf SEM from 172 f 14 to 212f22 ml/m2 at end-diastole and from 137f14 to 170 f 22 d / m 2 at end-systole; both p < 0.03). There were marked increases in LV and right ventricular filling pressure (from 17 f 2 to 36 f 3 mmHg and from 7 f 2 to 15 f 2 mmHg, respectively; both p O.8), but individual patients demonstrated substantial variability. Cardiac output rose less than in normals and increases were brought about primarily by subnormal heart rate increases. High resting and exercise systemic and pulmonary vascular resistance were indicative of limited vasodilator reserve. Despite marked hemodynamic abnormalities, 10 of the 20 subjects had well preserved exercise capacity ( 2 12 min exercise duration). These patients as a group had significantly lower resting heart rate and higher exercise cardiac output and lower exercise systemic vascular resistance. However, they did not differ from the other patients with respect to resting LV function. Thus, the exercise response in IDC has specific characteristics that distinguish it from normal and from the exercise response of other causes of LV dysfunction. An interesting subset of patients with IDC has well preserved exercise capacity associated with greater chronotropic and vasodilator reserve. This finding suggests less sympathetic activation in these subjects.

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 93%

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The exercise response in idiopathic dilated cardiomyopathy

Kirlin

Das

Zijnen

et al. 1984

Clinical Cardiology

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“…A study of castrated rats demonstrated that testosterone replacement led to an increase in LV mass, returning it back to pre-castration levels [32]. The increase in LV mass was in proportion to the change in body weight: the left ventricular weight/body weight ratio did not change [37]. A similar increase in LV mass was seen in human long distance runners and weight lifters, with LV mass increasing only to the extent that lean body mass is increased [33].…”

Section: Discussionmentioning

confidence: 91%

“…While semisupine bicycle ergometry results in lower peak heart rates and less change in ejection fractions in some radionuclide studies, the ability to detect CAD was no different using upright or supine exercise in these studies [35][36][37]. Patients with contrast allergies, renal insufficiency and those unable to exercise cannot undergo this CT evaluation.…”

Section: Limitationsmentioning

confidence: 88%

Effect of Testosterone and Resistance Training on Cardiac Mass and Contractility in Men with COPD

Budoff¹,

Mao²,

Rambod³

et al. 2011

J Allergy Ther

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Introduction: Testosterone therapy and resistance training have been demonstrated to improve muscle mass and strength in patients with testosterone deficiency. However the effects on cardiac mass and contractility of these interventions have not been identified in prospective placebo-controlled trials. The hypothesis of this trial was that resistance training and testosterone replacement would improve cardiac mass and contractility in male COPD patients with low testosterone levels. Methods:We conducted a 10 week trial in a 2 by 2 factorial design, randomizing 53 patients to replacement doses of testosterone enanthate (100 mg weekly) or placebo, as well as to a program of lower extremity resistance training or no exercise. We performed rest and exercise cardiac computed tomography (CCT) studies before and after 10 weeks of therapy to evaluate right and left heart function. Patients were injected with 40-50 ml of non-ionic, iodinated contrast and cine CCT images were obtained at rest. Patients were exercised to 60% of their maximal work rate on a semi-supine ergometer, then re-injected with another bolus of 40-50 ml of contrast and re-imaged. We evaluated cardiac output and left ventricular (LV) and right ventricular (RV) mass, LV and RV stroke volume, ejection fractions and end-diastolic volumes at rest and exercise, before and after therapy.Results: 42 men with COPD (mean FEV 1 =40%pred. pre-bronchodilator) and low testosterone levels (mean=320ng/dl) completed the 10 week protocol. Factorial analysis demonstrated that testosterone, but not resistance training increased LV and RV mass (by 4.9% and 8.3%, respectively). Resistance training, but not testosterone, was associated with increased LV ejection fraction at rest and during exercise (by 5.5% and 4.4%, respectively). In the entire study group, increases in both left and right ventricular mass were correlated with increases in lean body mass (assessed by DEXA) (r=0.49 and r=0.65, respectively). Conclusions:In men with COPD, testosterone replacement and strength training are associated with distinct alterations in cardiac structure and function. Specifically, resistance training improved ejection fraction, while testosterone increased lean body mass and LV mass.

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Research Considerations in the Measurement of Relative Exercise Performance

Margulis¹,

Katz²

1985

Arch Intern Med

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Left and right ventricular function at rest and during bicycle exercise in the supine and sitting positions in normal subjects and patients with coronary artery disease

Cited by 94 publications

References 36 publications

The exercise response in idiopathic dilated cardiomyopathy

The exercise response in idiopathic dilated cardiomyopathy

Effect of Testosterone and Resistance Training on Cardiac Mass and Contractility in Men with COPD

Research Considerations in the Measurement of Relative Exercise Performance

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