The relationship between biventricular myocardial performance and metabolic parameters during incremental exercise and recovery in healthy adolescents

Abstract

Pieles GE, Gowing L, Forsey J, Ramanujam P, Miller F, Stuart AG, Williams CA. The relationship between biventricular myocardial performance and metabolic parameters during incremental exercise and recovery in healthy adolescents. Am J Physiol Heart Circ Physiol 309: H2067-H2076, 2015. First published October 23, 2015 doi:10.1152/ajpheart.00627.2015 and right ventricular (RV) myocardial reserve during exercise in adolescents has not been directly characterized. The aim of this study was to quantify myocardial performance response to exercise by using two-dimensional (2-D) speckle tracking echocardiography and describe the relationship between myocardial reserve, respiratory, and metabolic exercise parameters. A total of 23 healthy boys and girls (mean age 13.2 Ϯ 2.7 yr; stature 159.1 Ϯ 16.4 cm; body mass 49.5 Ϯ 16.6 kg; BSA 1.47 Ϯ 0.33 m 2 ) completed an incremental cardiopulmonary exercise test (25 W·3 min increments) with simultaneous acquisition of 2-D transthoracic echocardiography at rest, each exercise stage up to 100 W, and in recovery at 2 min and 10 min. Two-dimensional LV (LV Sl) and RV (RV Sl) longitudinal strain and LV circumferential strain (LV Sc) were analyzed to define the relationship between myocardial performance reserve and metabolic exercise parameters. Participants achieved a peak oxygen uptake (V O2peak) of 40.6 Ϯ 8.9 ml·kg Ϫ1 ·min Ϫ1 and a work rate of 154 Ϯ 42 W. LV Sl and LV Sc and RV Sl increased significantly across work rates (P Ͻ 0.05). LV Sl during exercise was significantly correlated to resting strain, V O2peak, oxygen pulse, and work rate (0.530 Յ r Յ 0.784, P Ͻ 0.05). This study identifies a positive and moderate relationship between LV and RV myocardial performance and metabolic parameters during exercise by using a novel methodology. Relationships detected present novel data directly describing myocardial adaptation at different stages of exercise and recovery that in the future can help directly assess cardiac reserve in patients with cardiac pathology. CARDIOVASCULAR EXERCISE RESPONSE is a complex interplay between respiratory, metabolic, cardiac, and muscular adaptations and is traditionally assessed in children by using cardiopulmonary exercise testing (CPET) (1, 34). CPET has been used in diagnosis and risk stratification in children with heart disease (38) as it can impose physiological stress on the cardiovascular system to determine submaximal and maximal capacity, while numerous studies in adults with cardiovascular disease have shown CPET is a strong predictor of clinical outcome (2). Two methodological limitations of CPET are, however, the inability to provide data on myocardial function in response to the imposed exercise stress, the dominant process being to increase cardiac output to enhance oxygen delivery (3), and its limited and indirect inferences of cardiac reserve.Over the last decade these methodological constraints have led to several pilot studies directly investigating cardiac function during exercise in the healthy pediatric population by using echoca...

Left ventricular function during exercise in trained pre‐adolescent soccer players

“…There is a paucity of research with respect to the quantification of regional wall deformation during exercise in pre‐adolescent populations. Recent work by Pieles et al demonstrated a pattern of increased peak longitudinal ε from rest with a subsequent plateau during submaximal, supine cycle ergometry in recreationally active boys and girls (13.2 years). Furthermore, adult data during supine and semi‐supine exercise also demonstrates a similar a pattern for peak longitudinal ε .…”

“…The emergence of speckle tracking echocardiography (STE), which reliably assesses regional myocardial tissue deformation in the longitudinal plane of motion has the potential to provide further mechanistic insight into the link between LV performance and maximal aerobic capacity. There are a small number of studies that have characterized cardiac deformation during exercise in the child and adolescent populations . To date, this approach has not been adopted in highly trained pre‐adolescent soccer players in an attempt to differentiate the impact of training status on regional LV function.…”

Right Ventricular Dysfunction Impairs Effort Tolerance Independent of Left Ventricular Function Among Patients Undergoing Exercise Stress Myocardial Perfusion Imaging

“…For example, among a cohort of 23 healthy adolescents undergoing cardiopulmonary exercise testing, Pieles et al reported that both RV and LV strain increased in relation to work rate (p<0.05). 32 Moreover, among 44 chronic obstructive pulmonary disease patients, Caminiti et al reported that those with RV dysfunction (as defined via TAPSE) had lower effort tolerance on baseline 6 minute walk test (p=0.02) and lesser improvement following cardiopulmonary rehabilitation (p<0.001). 33 Other studies conducted among patients with LV systolic dysfunction have linked reduced RVEF to impaired exercise capacity as measured via peak oxygen consumption (V0 2 max) during bicycle ergometry or treadmill exercise.…”

Global and regional left ventricular circumferential strain during incremental cycling and isometric knee extension exercise

“…Still, Doucende et al did not observe a statistically significant increase between final work intensities, making it difficult to determine whether at 40% maximal workload, GCS begins to plateau thereafter or larger workload increments are necessary to elicit notable differences between exercise intensities. Further, circumferential shortening during exercise also shows regional disparity between apical and basal planes, with increases at the apex (ACS) without changes at the base (BCS), which, however, contrasts another investigation having reported a reserve in BCS compared with baseline …”

“…Further, circumferential shortening during exercise also shows regional disparity between apical and basal planes, with increases at the apex (ACS) without changes at the base (BCS), 9,10 which, however, contrasts another investigation having reported a reserve in BCS compared with baseline. 11 Data pertaining to circumferential strain during resistance exercise are limited. Reductions in GCS were noted during isometric hand-grip exercises 7,12 ; however, regional strains were not independently reported.…”