Non-invasive assessment of the performance of the right heart during dynamic exercise, a study of left-sided heart disease.
A simplified, non-invasive method for assessment of the performance of the right heart during supine leg exercise was described, which necessitated no more than a bicycle "ergometer" for leg exercise, a radiocardiograph for recording cardiac index (CI) and a "water" manometer for measuring cubital venous pressure (VP). Because the use of a cardiac catheter was omitted, right atrial pressure (RA), right ventricular diastolic pressure (RVd) or pulmonary arterial pressure (PA) were not measured. In 11 healthy subjects and 25 patients with primarily left-sided valvular disease and hypertension, the observed shift of CI-VP plot with exercise was similar to the published records of exercise-induced shift of CI-RA plot or CI-RVd plot in normal subjects and the same types of heart disease. With levels of load used in this study, a dividing line separating normal from abnormal elevation of VP during supine leg exercise (deltaVP) could be drawn at deltaVP = 35 mm H2O, because (1) none of the healthy subjects had deltaVP in excess of 35 mm H2O and (2) in these types of heart disease, deltaVP in excess of 35 mm H2O was always associated with a "subnormal" increase in CI (deltaCI less than 0.8 lit. min-1. M-2) with exercise, except in a few cases who appeared, clinically, to be in what may be termed "latent heart failure". Factors probably responsible for an impaired pumping ability of the right heart during exercise in left-sided heart disease were discussed, in relation to deltaVP.
D000328:Adult; D001810:Blood Volume; D002302:Cardiac Output; D005260:Female; D005725:Ganglia, Autonomic / Q000502:physiology; D006321:Heart / Q000503:physiopathology*; D006331:Heart Diseases / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D010101:Oxygen Consumption; D005082:Physical Exertion; D014690:Venous Pressure