Journal of Medical Ultrasonics

, Volume 46, Issue 1, pp 63–68 | Cite as

Changes in cardiac contractility during graded exercise are greater in subjects with smaller body mass index, and greater in men than women: analyses using wave intensity and force–frequency relations

  • Midori TanakaEmail author
  • Motoaki Sugawara
  • Kiyomi Niki
  • Yasuo Ogasawara
Original Article


Introduction and purpose

Estimation of the contractility of the left ventricle during exercise is an important part of the rehabilitation protocol. It is known that cardiac contractility increases with an increase in heart rate. This phenomenon is called the force–frequency relation (FFR). Using wave intensity, we aimed to evaluate FFR noninvasively during graded exercise.


We enrolled 83 healthy subjects. Using ultrasonic diagnostic equipment, we measured wave intensity (WD), which was defined in terms of blood velocity and arterial diameter, in the carotid artery and heart rate (HR) before and during bicycle ergometer exercise. FFRs were constructed by plotting the maximum value of WD (WD1) against HR. We analyzed the variation among FFR responses of individual subjects.


WD1 increased linearly with an increase in HR during exercise. The average slope of the FFR was 1.0 ± 0.5 m/s3 bpm. The slope of FFR decreased with an increase in body mass index (BMI). The slopes of FFRs were steeper in men than women, although there were no differences in BMI between men and women.


The FFR was obtained noninvasively by carotid arterial wave intensity (WD1) and graded exercise. The slope of the FFR decreased with an increase in BMI, and was steeper in men than women.


Cardiac contractility Echocardiography Graded exercise Force–frequency relation Wave intensity 



This work was supported in part by the Grant-in-Aid for Scientific Research (C 16k01570 and C 16H04264) from the Ministry of Education, Culture, Sports, Science and Technology of Japan.

Compliance with ethical standards

Ethical statement

All studies involved in this manuscript received approval from the Ethics Committee of Himeji Dokkyo University before study initiation. All subjects provided written informed consent prior to measurements.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Alpert NR, Leavitt BJ, Ittleman FP, et al. A mechanistic analysis of the force–frequency relation in non-failing and progressively failing human myocardium. Basic Res Cardiol. 1998;93:23–32.CrossRefGoogle Scholar
  2. 2.
    Hove-Madsen L, Gesser H. Force frequency relation in the myocardium of rainbow trout. Effects of K+ and adrenaline. J Comp Physiol B. 1989;159:61–9.CrossRefGoogle Scholar
  3. 3.
    Kambayashi M, Miura T, Oh BH, et al. Enhancement of the force–frequency effect on myocardial contractility by adrenergic stimulation in conscious dogs. Circulation. 1992;86:572–80.CrossRefGoogle Scholar
  4. 4.
    Miura T, Miyazaki S, Guth BD, et al. Influence of the force–frequency relation on left ventricular function during exercise in conscious dogs. Circulation. 1992;86:563–71.CrossRefGoogle Scholar
  5. 5.
    Ross J Jr, Miura T, Kambayashi M, et al. Adrenergic control of the force–frequency relation. Circulation. 1995;92:2327–32.CrossRefGoogle Scholar
  6. 6.
    Bhargava V, Shabetai R, Mathiasen RA, et al. Loss of adrenergic control of the force–frequency relation in heart failure secondary to idiopathic or ischemic cardiomyopathy. Am J Cardiol. 1998;81:1130–7.CrossRefGoogle Scholar
  7. 7.
    Kass DA. Force–frequency relation in patients with left ventricular hypertrophy and failure. Basic Res Cardiol. 1998;93:108–16.CrossRefGoogle Scholar
  8. 8.
    Maier LS, Schwan C, Schillinger W, et al. Gingerol, isoproterenol and ouabain normalize impaired post-rest behavior but not force–frequency relation in failing human myocardium. Cardiovasc Res. 2000;45:913–24.CrossRefGoogle Scholar
  9. 9.
    Morimoto R, Okumura T, Bando YK, et al. Biphasic force–frequency relation predicts primary cardiac events in patients with hypertrophic cardiomyopathy. Circulation. 2017;81:368–75.CrossRefGoogle Scholar
  10. 10.
    Mulieri LA, Hasenfuss G, Leavitt B, et al. Altered myocardial force–frequency relation in human heart failure. Circulation. 1992;85:1743–50.CrossRefGoogle Scholar
  11. 11.
    Mulieri LA, Leavitt BJ, Wright RK, et al. Role of cAMP in modulating relaxation kinetics and the force–frequency relation in mitral regurgitation heart failure. Basic Res Cardiol. 1997;92:95–103.CrossRefGoogle Scholar
  12. 12.
    Mulieri LA, Tischler MD, Martin BJ, et al. Regional differences in the force–frequency relation of human left ventricular myocardium in mitral regurgitation: implications for ventricular shape. Am J Physiol Heart Circ Physiol. 2005;288:H2185–91.CrossRefGoogle Scholar
  13. 13.
    Mullens W, Bartunek J, Tang WH, et al. Early and late effects of cardiac resynchronization therapy on force–frequency relation and contractility regulating gene expression in heart failure patients. Heart Rhythm. 2008;5:52–9.CrossRefGoogle Scholar
  14. 14.
    Pieske B, Kretschmann B, Meyer M, et al. Alterations in intracellular calcium handling associated with the inverse force–frequency relation in human dilated cardiomyopathy. Circulation. 1995;92:1169–78.CrossRefGoogle Scholar
  15. 15.
    Schmidt U, Schwinger RH, Bohm M, et al. Alterations of the force–frequency relation depending on stages of heart failure in humans. Am J Cardiol. 1994;74:1066–8.CrossRefGoogle Scholar
  16. 16.
    Schotten U, Voss S, Wiederin TB, et al. Altered force–frequency relation in hypertrophic obstructive cardiomyopathy. Basic Res Cardiol. 1999;94:120–7.CrossRefGoogle Scholar
  17. 17.
    Schwinger RH, Bohm M, Koch A, et al. Force–frequency relation in human heart failure. Circulation. 1992;86:2017–8.CrossRefGoogle Scholar
  18. 18.
    Vollmann D, Luthje L, Schott P, et al. Biventricular pacing improves the blunted force–frequency relation present during univentricular pacing in patients with heart failure and conduction delay. Circulation. 2006;113:953–9.CrossRefGoogle Scholar
  19. 19.
    Miao DM, Ye P, Zhang JY, et al. Clinical usefulness of carotid arterial wave intensity in noninvasively assessing left ventricular performance in different hypertensive remodeling hearts. Zhongguo Ying Yong Sheng Li Xue Za Zhi. 2011;27:136–9.Google Scholar
  20. 20.
    Niki K, Sugawara M, Chang D, et al. A new noninvasive measurement system for wave intensity: evaluation of carotid arterial wave intensity and reproducibility. Heart Vessels. 2002;17:12–21.CrossRefGoogle Scholar
  21. 21.
    Ohte N, Narita H, Sugawara M, et al. Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance. Heart Vessels. 2003;18:107–11.CrossRefGoogle Scholar
  22. 22.
    Sugawara M, Niki K, Ohte N, et al. Clinical usefulness of wave intensity analysis. Med Biol Eng Comput. 2009;47:197–206.CrossRefGoogle Scholar
  23. 23.
    Vriz O, Favretto S, Jaroch J, et al. Left ventricular function assessed by one-point carotid wave intensity in newly diagnosed untreated hypertensive patients. J Ultrasound Med. 2017;36:25–35.CrossRefGoogle Scholar
  24. 24.
    Wang Z, Jalali F, Sun YH, et al. Assessment of left ventricular diastolic suction in dogs using wave-intensity analysis. Am J Physiol Heart Circ Physiol. 2005;288:H1641–51.CrossRefGoogle Scholar
  25. 25.
    Zhang H, Zheng R, Qian X, et al. Use of wave intensity analysis of carotid arteries in identifying and monitoring left ventricular systolic function dynamics in rabbits. Ultrasound Med Biol. 2014;40:611–21.CrossRefGoogle Scholar
  26. 26.
    Tanaka M, Sugawara M, Ogasawara Y, et al. Noninvasive evaluation of left ventricular force–frequency relationships by measuring carotid arterial wave intensity during exercise stress. J Med Ultrason. 2015;42:65–70.CrossRefGoogle Scholar
  27. 27.
    Seo JS, Jin HY, Jang JS, et al. The relationships between body mass index and left ventricular diastolic function in a structurally normal heart with normal ejection fraction. Cardiovasc Ultrasound. 2017;25:5–11.CrossRefGoogle Scholar
  28. 28.
    Janssen PML. Myocardial contraction-relaxation coupling. Am J Physiol Heart Circ Physiol. 2010;299:H1741–9.CrossRefGoogle Scholar

Copyright information

© The Japan Society of Ultrasonics in Medicine 2018

Authors and Affiliations

  1. 1.Faculty of Health Care SciencesHimeji Dokkyo UniversityHimejiJapan
  2. 2.Tokyo Women’s Medical UniversityTokyoJapan
  3. 3.Himeji Dokkyo UniversityTokyoJapan
  4. 4.Tokyo City UniversityTokyoJapan
  5. 5.Kawasaki University of Medical WelfareKurashikiJapan

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