Turk Kardiyol Dern Ars. 2005; 33(5): 268-275

The effect of exercise on a bicycle ergometer on diastolic filling parameters in patients with diastolic dysfunction

Arda Şanlı Ökmen¹, Aydın Yıldırım¹, Özer Soylu¹, Seden Erten Çelik¹, Ertan Ökmen¹, Tuna Tezel¹

OBJECTIVES
During the early stages of diastolic dysfunction, symptoms of heart failure including dyspnea and fatigue become manifest only during exercise. The aim of this study was to evaluate the changes in the left ventricular diastolic filling parameters during exercise and their relationship with ensuing symptoms in patients with abnormal relaxation (grade 1 diastolic dysfunction).
STUDY DESIGN
The study included 49 patients (27 females, 22 males; mean age 56±8 years; range 36 to 77 years) with grade 1 diastolic dysfunction, without ischemic heart disease or any other echocardiographic abnormalities, and 16 healthy controls (9 females, 7 males; mean age 54±12 years; range 33 to 61 years). Forty patients (81.6%) had hypertension. Diastolic function parameters during rest and at maximal exercise (performed by bicycle ergometer) were recorded, and response to exercise and relationship with symptoms were assessed.
RESULTS
In the patient group, E and A wave amplitudes and the E/A ratio significantly increased at maximal exercise (80%, p=0.0003; 44%, p=0.0004; 25%, p: 0.0004, respectively), with a slight decrease in the deceleration time (p=0.07). A similar increase was observed in E wave velocity (68%) in the control group, but this was not significant when compared with the absolute values of increase in the patient group. However, the increase in A wave velocity (76%) was significant when compared with the absolute values of increase in the patient group (p=0.011). The E/A ratio did not change significantly in the control group because of similar increases in E and A velocities.
CONCLUSION
Despite a relative increase in the E/A ratio, exercise-related dyspnea and fatigue seen in patients with diastolic dysfunction may be associated with an increased preload, decreased deceleration time, and an insufficient increase in active filling velocity (A wave velocity).

Keywords: Blood flow velocity; diastole; echocardiography, Doppler; exercise test/methods; hypertension/physiopathology; ventricular dysfunction, left; ventricular function, left

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