Adaptation of the left ventricular function parameters to dynamic exercise in aortic stenosis

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Abstract
The left ventricular volumes, the left ventricular ejection fraction, the stroke volume index and the cardiac index were non-invasively determined in 47 patients suffering from moderate to severe pure aortic stenosis using radionuclide angiography at rest and at peak supine exercise. Each patient was previously submitted to right and left heart catheterization and to selective coronary angiography. The left ventricular ejection fraction decreased significantly during exercise (0·62±0·09 to 0·59±0·09, Pr=0·84, Pr=−0·42, P<0·05). No relation existed between stroke volume index variations and any other variables, particularly systolic gradient, aortic valve area and resting left ventricular ejection fraction. The results suggest that, in aortic stenosis, the adaptation of the left ventricular pump function during exercise is mostly dependent upon the diastolic properties of the left ventricular wall and is limited by the progression of left ventricular hypertrophy, i.e. diastolic stiffness. By contrast, the role of the basal systolic pump function and of the severity of the valvular obstruction seems of limited importance.

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