Exercise Hemodynamics in Patients with Heart Failure
The concept of ventriculo-arterial coupling provides a useful framework to understand the exercise response in normal and failing hearts. Ventricular and arterial properties are matched so as to optimize ventricular work efficiency in normal hearts and to maximize stroke work in moderately depressed hearts. Exercise capacity is generally reduced in failing hearts. Thereby, decreases in anaerobic threshold and peak oxygen consumption are inversely related to the resting plasma catecholamine levels.
During anaerobic exercise, stroke volume is augmented by an increase in contractility and an enhanced mechanical efficiency in normal subjects, whereas in patients with cardiac dysfunction, stroke volume is augmented through an increase in ventricular volume without any change in both ventricular and arterial volume elastance. Thus, the regulation of stroke volume during exercise shifts from a catecholamine-mediated reduction in end-systolic volume to a greater reliance on the Frank-Starling mechanism.
KeywordsStroke Volume Anaerobic Threshold Stroke Work Arterial Elastance Plasma Norepinephrine Level
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