Mitral annular excursion during exercise in endurance athletes

Abstract

The aim of the present study was to quantify the left ventricular (LV) longitudinal motion during exercise at rest and during upright exercise in 24 healthy male endurance athletes. By using M-mode and two-dimensional echocardiography, the relative mitral annular motion and the absolute LV longitudinal axis was measured at end-diastole and end-systole at rest and during exercise. From rest to peak exercise at a heart rate of 160 beats per minute (bpm) the mitral annular motion increased in the septal and lateral annular borders by 68% and 49% respectively. At rest, mitral annular excursion was significantly (13%) higher in the lateral than in the septal wall but at peak exercise at a heart rate of 160 bpm there was no difference between the septal and lateral annular motion. The total end-diastolic LV axial length did not increase from rest to peak exercise. In conclusion, during upright exercise, mitral annular motion increased significantly with no difference between the septal and lateral annular excursion at peak exercise. The absolute increase in mitral annular motion during exercise was explained by a decrease in axial end-systolic length.

Moderate intensity supine exercise causes decreased cardiac volumes and increased outer volume variations: a cardiovascular magnetic resonance study

“…In contrast to a previous study of upright exercise on an ergometer cycle where the left ventricular valve displacement was significantly increased during exercise [20], our results showed unchanged LV AVPD and longitudinal contribution to LVSV. Right ventricular valve displacement (RV AVPD) remained unchanged but together with the decreased volume of the right ventricle, the right ventricular longitudinal contribution to SV was significantly decreased.…”

“…At rest the longitudinal contribution to SV has been shown to be 60% for the LV and 80% for the RV and radial contribution is 40% and 20% respectively [15,17,19]. It has been shown that during exercise there is a significant increase in the mitral valve displacement during exercise [20]. Longitudinal pumping is calculated as the atrio-ventricular plane displacement (AVPD) multiplied by the short-axis area of the ventricle and an increase in AVPD may therefore affect the longitudinal contribution to SV.…”

Left ventricular end‐diastolic geometrical adjustments during exercise in endurance athletes

“…, 2007). Furthermore, as the absolute axial annular excursion increased more in the septal than in the lateral part of the annulus and the axial end‐diastolic length (measured from epicardial apex to mitral annulus) remained unchanged during exercise (Sundstedt et al. , 2008), it is to be expected, according to the Frank–Starling mechanism, that during exercise the relative increase in septal short‐axis stretch is greater than the stretch produced in the lateral free wall.…”

“…, 2004). As the augmentation in LV end‐diastolic volume during exercise could not be explained by an increase in the absolute axial cavity length measured from the epicardial apex to mitral valve annulus (Sundstedt et al. , 2008), the only reasonable explanation is that the augmentation in LV end‐diastolic volume is caused by an increase in the short‐axis cardiac diameters, thereby creating a more spherical LV during exercise.…”

Atrial aspiration from pulmonary and caval veins is caused by ventricular contraction and secures 70% of the total stroke volume independent of resting heart rate and heart size

“…When the AV-plane is displaced apically during ventricular systole, dP/ dV is below zero and blood is aspirated into the atria from the pulmonary and caval veins. Echocardiographic studies have shown AVPD to increase during exercise (Slordahl et al, 2004;Sundstedt et al, 2008), suggesting an increased longitudinal contribution and a greater systolic atrial filling at higher HR. A greater systolic atrial filling decreases the outer volume change of the heart and synchronizes in-and outflow (Lundb€ ack, 1986), which may make the heart more energy efficient.…”