title: Exertional hemodynamics in women with chest pain--an aortic Doppler ultrasound study.
abstract: Aortic ultrasound Doppler recordings of stroke volume, maximal flow velocity, and acceleration can be used to assess central hemodynamic effects of exercise in coronary artery disease (CAD) and left ventricular dysfunction. We wanted to evaluate the time course and amplitude of changes in aortic Doppler ultrasound parameters in women during supine exercise and the potential diagnostic value of a submaximal supine exercise test. For this purpose, 18 women who had undergone coronary angiography because of incapacitating chest pain (10 with significant coronary stenoses and previous myocardial infarction, 8 without stenoses or infarction) were compared with 10 healthy controls. Pathological electrocardiographic (ECG) ST-segment depression during supine exercise was common in all groups. In the control group, a significant increase of stroke volume (10%), maximal aortic flow velocity (27%), and acceleration (43%) occurred at low load during exercise. Women with CAD showed no increase and a lower cardiac output during exercise, indicating left ventricular dysfunction. Women with syndrome X resembled the controls but had a higher maximal flow velocity at rest, which may indicate hyperdynamic circulation. We conclude that a test up to 40% of seated maximal load is valuable and often sufficient when assessing the hemodynamic effects of supine exercise by Doppler ultrasound in terms of stroke volume, maximal flow velocity, and acceleration. By characterizing left ventricular function in groups of female patients where false-positive stress ECG reactions are common, Doppler ultrasound may contribute to the understanding and clinical management of women with chest pain.
authors.affiliation: Department of Clinical Physiology, Linköping Heart Center, University Hospital, Sweden.
authors.forename: B J
authors.initials: BJ
authors.lastname: Sjöberg
authors.forename: E
authors.initials: E
authors.lastname: Swahn
authors.forename: B
authors.initials: B
authors.lastname: Wranne
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D015444:Exercise / Q000502:physiology; D005080:Exercise Test / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology