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Physiological systolic and diastolic changes of the left and right heart during exercise stress echocardiography

Stefan A. Lange1, Martin U. Braun2, Jens Jung3
1Medizinische Klinik I, Kardiologie und Angiologie, Asklepios Harzklinik Goslar, Akademisches Lehrkrankenhaus der Johannes-Gutenberg-Universität, Göttingen, Germany; 2Medizinische Klinik I, Kardiologie, Elektrophysiologie und Intensivmedizin, Klinikum Bamberg, Akademisches Lehrkrankenhaus der Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany; 3Medizinische Klinik I, Kardiologie und Angiologie, Klinikum Worms, Akademisches Lehrkrankenhaus der Johannes-Gutenberg-Universität, Mainz, Germany

[Applied Cardiopulmonary Pathophysiology 16: 37-54, 2012]


Objective: The aim of this study was to evaluate echocardiography parameters of the left and right heart function during exercise.
Methods: We studied 20 healthy, normal trained volunteers (10 male). All participants underwent an echocardiography at rest and during exercise.
Results: At peak exercise, higher echocardiography values were achieved in men for the tissue Doppler imaging (TDI) s’ at the mitral valve annulus (MVA). During exercise, peak early diastolic filling velocity (E Vmax), peak late diastolic filling velocity (A Vmax), and pulmonary vein flow increased significantly. E/A ratio, deceleration time (DT) and isovolumic relaxation time (IVRT) decreased significantly. The TDI velocities e’ and s’ (MVA) increased significantly.
There were linear correlations between workload (METS) and the mitral and pulmonary vein flow, the ratios of diastolic filling (E/e’) and the TDI velocities (MVA). The best correlation was obtained for METS and s’ (r² =0.5).
During exercise, parameters of the right heart e.g. the tricuspid annulus plane systolic excursion and the TDI parameters at the lateral tricuspid valve annulus (TVA) ea and sa increased significantly. The right ventricular systolic pressure (RVSP) increased during exercise but stayed in a normal range.
There were linear correlations between workload and ea, sa, TAPSE and RVSP. The best correlation was achieved for METS and sa (r² = 0.49).
Conclusion: Systolic and diastolic parameters of the left and right heart changed during exercise in relation to workload, but E/e’ ratio and RVSP stayed in a normal range.

Key words: exercise stress echocardiography, tissue doppler imaging, right heart function, left heart function, workload

Correspondence address
Stefan A. Lange, M.D.
Medizinische Klinik I
Kardiologie und Internistische Intensiv-
Asklepios Harzklinik Goslar
Kösliner Str. 12
38642 Goslar
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