Dynamics of changes in the cardiovascular response to submaximal exercise during low-intensity endurance training with particular reference to the systolic time intervals

Eighteen male volunteers (aged 20-23 years), not involved in any sporting activities, were submitted to 13 weeks of training consisting of 30 min exercise [at 50%-75% maximal oxygen intake (VO2max)] on a cycle ergometer, performed 3 times a week. Every 4 weeks cardiac function was evaluated by measuring the systolic time intervals at rest and during submaximal cycle exercise. Stroke volume (SV), heart rate (HR) and blood pressure (BP) responses to submaximal exercise, VO2max and anaerobic threshold (AT) were also determined. Significant increases in VO2max, increases in AT and SV at the submaximal exercise intensities, as well as decreases in HR and BP were found after 4 weeks of training. Resting systolic time intervals were not affected by training, but during the submaximal cycle exercise the values of the pre-ejection period (PEP) and isovolumic contraction time (ICT) corresponding to HR of 100 beats.min-1 were significantly lowered after 13 weeks of training, whereas PEP, ICT and total electromechanical systole corresponding to HR of 130 beats.min-1 were significantly shortened by the 4th week. The ratios of PEP:LVET (left ventricular ejection time) and ICT:LVET during submaximal exercise were significantly lowered by training starting from the 8th week. These changes might be interpreted as evidence of the training-induced enhancement of the "contractility reserve", i.e. the ability to increase heart muscle contractility with increasing exercise intensity.     

Human cardiovascular reactions to simulated hypovolaemia, modified by the opiate antagonist naloxone

Six healthy males were exposed to 20 mm Hg lower body negative pressure (LBNP) for 8 min followed by 40 mm Hg LBNP for 8 min. Naloxone (0.1 mg.kg-1) was injected intravenously during a 1 h resting period after which the LBNP protocol was repeated. Systolic, mean, and diastolic arterial blood pressures (SAP, MAP, DAP), and central venous pressure (CVP) were obtained using indwelling catheters. Cardiac output (CO), forearm blood flow (FBF), heart rate (HR), left ventricular ejection time (LVET), and electromechanical systole (EMS) were measured non-invasively. Pulse pressure (PP), stroke volume (SV), total peripheral resistance (TPR), forearm vascular resistance (FVR), systolic ejection rate (SER), pre-ejection period (PEP), PEP/LVET and indices for the systolic time intervals (LVETI, EMSI, PEPI) were calculated. During the second LBNP exposure, only two parameters differed from the pre-injection values: DAP at LBNP = 40 mm Hg increased from 60.0 +/- 4.8 mm Hg to 64.8 +/- 4.1 mm Hg (N = 4, p less than 0.02) and LVETI at LBNP = 20 mm Hg increased from 384.4 +/- 5.2 ms to 396.8 +/- 6.2 ms (N = 6, p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of static exercise and muscle ischemia on cardiac function as evaluated by the systolic time intervals

To determine the role of muscle chemoreflex in the cardiac response to static exercise the effect of the forearm muscle ischemia on systolic time intervals (STI), heart rate (HR) and blood pressure (BP) recovery following static handgrip was studied in 7 healthy men. During handgrip maintained for 4 min at 30% maximal voluntary contraction HR and BP increased significantly while duration of the pre-ejection period (PEP) and isovolumic contraction time (ICT) were shortened with a significant lowering in the ratio of PEP to the left ventricle ejection time (LVET). Occlusion of the circulation to the forearm muscles for 2 min after cessation of exercise did not prevent a rapid decline of HR or increment in PEP, ICT and PEP-to-LVET ratio while BP remained elevated for as long as blood flow to muscles was restricted. The study failed to demonstrate an appreciable effect of muscle chemoreflex on HR or myocardial contractility, suggesting that input from muscle afferents activated by metabolic stimuli induces the pressor response mainly by the peripheral vasoconstriction.     

Polycardiographic evaluation of left ventricular function in the elderly]

Polycardiographic recordings have been carried out in 57 individuals (16 men and 41 women), aged between 70 and 97 years (mean age 78.3 years), both at rest and during the stimulation of circulatory system by the cooling of hand. Systolic time intervals of the left ventricle and QT/QS2 ratio have been evaluated. It was found, that systolic time intervals at rest did not differ significantly from those given by Weissler. Cooling of hand has been manifested by: prolongation of LVETI, decrease in PEP/LVET, prolongation of QS2I, and decrease in QT/QS2. Results suggest indirectly that myocardium of the elderly adapts to the stimulation through Frank-Sterling mechanism.     

Systolic time intervals in burn injury

Systolic time intervals were studied in 28 young, previously healthy burn patients (TBS 10-90%) on 145 occasions. A NEK 116 type 3 channel recorder of 100 mm/sec paper speed was used. Synchronous ECG recordings in lead II, PCG in the m "1" frequency band, and external carotid pulse tracings were recorded. RR, QS2, S1S2, LVET, PEP, PEP/LVET and QT, QTc, QS2-QT intervals were measured in 5-10 cardiac cycles in each of the examinations. Calculation of the additional parameters ICT, LVET/ICT, DT, EVR, PRP, EF and SV values were correlated to the extent of, and the time elapsed since, burn injury. The derivated parameters and statistical analysis were performed on a Commodore 64 type computer based on a software program. Elongation of QTc (greater than 440 msec) and frequent electrodynamic failure (QT-QS2 greater than 40 msec) especially during the first postinjury week were found characteristic in severe injury. In 53% the PEP/LVET ratio was less than 0.31, mean 0.32 +/- 0.093. In 21 cases of severe hypovolaemia the increase of PEP raised this value beyond 0.41. With the exception of 3 examinations, QS2I was normal or shortened. Calculated EF were normal or increased, SV reduced being interdependent with burn extent and shortening of DT. In patients with severe burns, oxygenization was inadequate (EVR less than 0.8); it showed an inverse correlation to HR. The simultaneously high LVET/ICT ratio and shortened ICT values pointed to an increase in contractility.     

运动负荷对青年学生和运动员心脏功能的影响

用无创法(阻抗法)测量了40名青年学生和40名运动员在两种运动负荷(50W和150W)运动前、运动后即刻和恢复时程的收缩时间间期(STI)和心率(HR)。在静态时,“运动员组”的心率较缓(P<0.01)、QS_1较长(P<0.05)、PEP/LVET比值较大(P<0.05和P<0.01)、LVETc较短(P<0.001)。运动后即刻,“学生组”和“运动员组”都表现为QS_z、LVET、PEP、IVCT、QS_1缩短、PEP/LVET比值减小、心率增速和LVETc延长。但“运动员组”QS_2、LYET的缩短和心率增速的程度较少,而PEP/LVET比值的减小和LVETc延长的程度较大。除PEP/LVET比值外,其余各项指标的恢复速度均与负荷量有关。“运动员组”的恢复速度较快,尤其在150W时更为明显。本文指出:1)用阻抗法测算动态下的STI更为实用;2)系统训练可提高心脏活动的潜力,改善泵功能,促进心脏活动的调节速度。     

心脏收缩时间间期与冠状动脉狭窄程度或范围的相关性研究

心脏收缩时间间期(STI)通过单笔心电图机叠加记录ECG、心音图和颈动脉图后测得。对83例患者进行了STI均值与选择性冠状动脉造影(CAG)及左室造影的相关研究。患者除陈旧性心肌梗塞及室壁瘤外,根据冠状动脉(CA)狭窄程度而分组。STI随CA狭窄程度及范围的增加而显著异常,提示心功能随心肌缺血程度加重而进行性恶化。左室射血分数(LVEF)的降低也支持这一点。CA狭窄程度、范围与射血前时间/左室射血时间(PEP/LVET)呈正相关。在决定左室功能的异常方面,PEP/LVET和LVEF的临床意义完全相同。提示STI在评价冠心病心功能上是有用的。排除影响STI的某些因素后,PEP/LVET≥0.38可作为判断冠心病左心功能减退的标志。但轻度CA狭窄患者的STI可正常,这可能与静息时尚有足够的CA贮备力有关。     

不同海拔高度对健康成年男性心脏血流动力学和心电图的影响

目的:监测中国南极冰盖考察预选队员心血管系统随海拔增高的变化,探讨筛查低氧易感队员和急性高原病的防治。方法:用无创血流动力学监护仪和十二导联心电图机,在北京(40 m)、拉萨(3 650 m)、羊八井(4 300 m)对第25次和26次南极冰盖考察预选队员心血管功能进行连续动态性监测。结果:随着海拔的增高,心率、收缩压、舒张压、平均动脉压、外周血管阻力、外周血管阻力指数显著升高(P0.05),心输出量、心指数、搏出量、搏出指数、加速度指数、速度指数、左心射血时间显著降低(P0.05),预射血期呈降低趋势(P0.05)。结论:随着海拔的增高,预选队员的外周血管阻力显著升高,左心泵血和收缩功能减弱且与Q-TC间期呈负相关。     

Cardiovascular, metabolic and plasma catecholamine responses to passive and active exercises.

Eight healthy male volunteers (aged 19.6+/-3.0 years) were submitted to the unloaded active (AE) and passive (PE) cycling exercise-tests performed on an adapted cycle ergometer at a pedalling rate of 50 rpm. Intensity of active exercise was about 10% of VO2 max. In the PE exercise test the ergometer was moved electrically. During both tests the systolic time intervals (STI), stroke volume (SV), heart rate (HR), blood pressure (BP), oxygen uptake (VO2), rating of perceived exertion (RPE), electrical muscle activity (EMG), plasma adrenaline (A), noradrenaline (NE) and blood lactate (LA) concentrations were measured. Exercise induced changes in VO2, RPE and EMG were significantly higher during AE than PE. Shortening of the pre-ejection period (PEP) and diminishing of the PEP to ejection time (ET) ratio were similar in both types of exercise, whereas HR increased only during AE. A significant increase in cardiac output (p<0.01) resulted from increased SV (p<0.01) during PE and from increased HR (p <0.01) during AE. MAP increased only during PE and it was higher than at rest and during AE (p<0.01). Absence of changes in SV and MAP during AE may be considered as a secondary effect of the decrease in TPR. Plasma catecholamines did not increase above resting values in either type of exercise. Blood LA concentration increased during both PE and AE but it reached higher values (p<0.01) after the latter test. The present data suggest that the inotropic state depends on the mechanoreflexes originated in skeletal muscles. However, contribution of changes in preload to shortening of PEP can not be excluded.     

Physiologic modulations of the systolic time intervals in the fetal lamb

To examine the modulation of fetal systolic time intervals of the ovine fetus in relation to fetal maturation, heart rate, respiratory activity, and circadian rhythm, studies were carried out on 13 fetal-maternal sheep preparations. The data obtained showed that there was a significant correlation between the ejection time (ET) and the RR intervals of the electrocardiogram. The pre-ejection period (PEP) and PEP/ET increased in relation to the fetal maturation (38 ms and 0.25 at 120 days to 52 ms and 0.33 at 145 days of gestation, respectively). When the circadian rhythmicity was analyzed, a relative tachycardia was in evidence during the 21- to 03-h period but systolic time intervals remained unchanged. Except for some tachycardia and cardiac rhythm variability, respiratory activity also had no influence on the systolic time intervals.     

Variation of cardiac cycle during prolonged cycling exercise

The purpose of this study was to elucidate the changes in heart rate (HR), systolic and diastolic time intervals accompanying prolonged cycling exercise. Seven healthy male students (N group) and seven male collegiate long distance runners (LDR group) underwent 60-min bicycle ergometer exercise loaded at 30% and 50% HRmax. Electrocardiogram (ECG) and phonocardiogram (PCG) were recorded throughout the exercise and recovery period, and then left ventricular ejection time (LVET) and left ventricular diastolic time (LVDT) were calculated from tracings of the cardiac cycle. In the N group, HR increased to the target HR level (30% and 50% HRmax) in the initial phase of exercise, but there was a tendency to increase 10-15 b/min in the latter half of the exercise period. The LDR group showed the same trend as in the N group at 50% HRmax level (i.e., 120 b/min) exercise. These increments of the HR were due to the decrease of stroke volume, the elevation of body temperature and changes in the volume of the venous return. In the initial phase of exercise (within five minutes), LVDT decreased markedly resulting in a rapid increase of the HR in both groups. The decrease in LVDT was 250-400 msec (60-70% decrement for resting value) at the 30% HRmax level load and 270-480 msec (73-80% decrement for resting value) at the 50% HRmax level load, and then transient slight increment was recognized. Subsequently, there was a tendency to decrease. The major factor for the increase of the HR was that the LVDT decreased markedly that implied the shortening of the inflow time to the left ventricle.(ABSTRACT TRUNCATED AT 250 WORDS)     

Some pathophysiological aspects of vibration-induced white finger

The level of sympathetic nervous activity was assessed by evaluating cardiovascular responses to a cold test in 63 vibration-exposed workers (50 subjects without vibration white finger (VWF) and 13 subjects at stages 1 and 2 of VWF) and in 41 controls. Blood pressure, heart rate, systolic time intervals and the skin temperature of the third finger of the right hand were monitored throughout the cold test period. Basal urinary excretion of free catecholamines and platelet aggregation indices both in vitro and in vivo were also determined in all subjects. Systolic time intervals such as electromechanical systole index (QS2I) and left ventricular ejection time index (LVETI) were found to be shorter in the vibration-exposed workers with and without VWF than in the controls, both at rest and during cold exposure and recovery (p less than 0.001). A significant inverse relationship between urinary free catecholamines and the duration of LVETI was observed under resting conditions (p less than 0.03). The recovery rate of the basal finger skin temperature after local cooling was slower in vibration workers with VWF than in those without VWF (p less than 0.05) and in the controls (p less than 0.001). Platelet aggregation indices were similar in all groups studied. The results suggest that the level of sympathetic nervous activity is higher in vibration-exposed workers than in controls. In subjects with VWF, sympathetic hyperactivity in combination with local factors such as vibration-induced hyperresponsiveness to cold of the digital vessels may be responsible for finger blanching attacks.(ABSTRACT TRUNCATED AT 250 WORDS)     

Increase in atrial natriuretic peptide in response to physical exercise

Circulating atrial natriuretic peptide (ANP) level was determined during physical exercise to investigate the correlation between changes in ANP level and heart rate increases. Six subjects exercised at a work level of 75% VO2max for 30 min, two also performed two successive exercises at 75% VO2max while two more exercised for longer at 55% VO2max. Plasma ANP levels and heart rate increased in all the exercising subjects. At the end of the exercise, the ANP level fell immediately, suggesting an immediate reduction in ANP secretion by the heart. Pre-exercise values were reached after 30 min. Successive exercises gave the same heart rate related ANP patterns without previous secretory episodes having any effect. These results lead to the conclusion that ANP intervenes in the cardiovascular adjustments to exercise.     

Global and Regional Left Ventricular Contractile Impairment in Patients with Wolff-Parkinson-White Syndrome

Background

To assess regional systolic function and global contractile function in patients with WPW Syndrome.

Method

Eleven cases with manifest Wolff-Parkinson-White (WPW) syndrome in sinus rhythm were compared to 11 age matched controls. 2D strain analysis was performed and peak segmental radial strain (pRS) values obtained from basal ventricular parasternal short-axis images (70 ± 5 frames/sec) using a dedicated software package. Heterogeneity of radial strain pattern in six circumferential basal left ventricular segments was measured in terms of standard deviations of peak RS (SD^pRS) or range (difference between maximum and minimum peak RS i.e. Range^pRS). Spectral Doppler (continuous wave) measurements were acquired through the left ventricular outflow tract to determine Pre Ejection Period (PEP), Left Ventricular Ejection Time (LVET) and measures of left ventricular systolic performance.

Results

LV segmental radial strain was profoundly heterogeneous in WPW cases in contrast to fairly homogenous strain pattern in normal subjects. Wide SD^pRS values 17.5 ± 8.9 vs 3.3 ± 1.4, p<0.001 and Range^pRS 42.7 ± 20.8 vs.8.5 ± 3.6 , p<0.001 were observed among WPW and healthy subjects respectively. PEP (132.4 ± 14.7 vs 4.7 ± 0.5ms, p<0.001) and corrected PEP (76.1 ± 8.0 vs 2.7 ± 0.4ms, p<0.001) were significantly longer in WPW patients compared to controls. The PEP/LVET ratio was also significantly greater in WPW cohort (0.49 ± 0.04 vs. 0.28 ± 0.05, p <0.001) suggesting global systolic dysfunction.

Conclusions

Patients with manifest preexcitation (predominantly those with right-sided pathways) have regional and global contractile dysfunction resulting from aberrant impulse propagation inherent to the preexcited state.     

Respiratory metabolism in patients during exercise therapy in the early period of acute myocardial infarction

Respiratory and cardiocirculatory response to rehabilitation calisthenics in 30 patients, aged 39-66 years, with recent myocardial infarction was studied. Respiratory exchange (Douglas-Haldane method), heart rate, blood pressure, oxygen pulse and electrocardiogram during exercise were investigated. Rehabilitation was performed between the 4th and 21st day of myocardial infarction, in 4 periods with gradually increasing effort, according to the model A designed at the Cardiology Institute in Warsaw. The time of exercises was 10-18 min, depending on the period of rehabilitation. It was found that lung ventilation, tidal volume, oxygen uptake and carbon dioxide output were increased by 20-40% during exercise of the I and II periods of rehabilitation and by 60-100% in the III and IV periods of mobilization. Energy cost of calisthenics rehabilitation was in the lightest case 13 kJ/min. The most increase in respiratory exchange caused exercises performed in sitting position, walking and stair climbing. The last type produced also the highest rise in heart rate (mean 20%) and systolic blood pressure (mean 17% of resting values).     

Muscle metaboreflex control of ventricular contractility during dynamic exercise

When oxygen delivery to active skeletal muscle is insufficient for the metabolic demands, afferent nerves within muscles are activated, which elicit reflex increases in heart rate (HR), cardiac output (CO), and arterial pressure (AP), termed the muscle metaboreflex (MMR). To what extent the increases in CO are the result of increased ventricular contractility is unclear. A widely accepted index of contractility is maximal left ventricular elastance (Emax), the slope of the end-systolic pressure-volume relationship, such as during rapidly imposed reductions in preload. The objective of the present study was to determine whether MMR activation elicits increases in Emax. Experiments were performed using conscious dogs chronically instrumented to measure left ventricular pressure and volume at rest and during mild or moderate treadmill exercise with and without partial hindlimb ischemia to elicit MMR responses. At both workloads, MMR activation significantly increased CO, HR, AP, and maximum rate of change of left ventricular pressure. During both mild and moderate exercise, MMR activation increased Emax to 159.6 +/- 8.83 and 155.8 +/- 6.32% of the exercise value under free-flow conditions, respectively. We conclude that the increase of ventricular elastance associated with MMR activation indicates that a substantial increase in ventricular contractility contributes to the rise in CO during dynamic exercise.     

Pre-ejection period controlled cardiac pacemaker

Numerous investigations have been performed in search for suitable parameters for physiologic adaptation of the pacing rate. In case of chronotropic incompetence corporeal as well as cardiac control parameters permit open or closed loop control of the pacing rate. Criteria to be considered are the patient's condition, the response time of the system, the proportionality to the oxygen uptake and the susceptibility to interference. A high specificity of the rate response is particularly important for the patient with a low cardiac reserve. The use of a parameter relating to the central hemodynamics, such as the systolic time intervals, particularly the pre-ejection period (PEP), as input signal for rate control is, therefore, of special interest. The concept presented of a PEP-controlled rate adaptive pacemaker is based on the linear proportionality between PEP and the cardiac cycle length. Changing with the sympathetic tone, the PEP permits adaptation of the pacing rate in response to physical as well as emotional stress. The right ventricular PEP parallels the left ventricular one and is measured between the electrode tip and the pacemaker housing. Clinical results obtained confirm the high sensitivity and specificity of this control parameter with respect to the metabolic demand. Technical details of an implantable multiprogrammable device are dealt with.     

Left ventricular systolic performance during prolonged strenuous exercise in female triathletes

BACKGROUND: The effect of prolonged strenuous exercise (PSE) on left ventricular (LV) systolic function has not been well studied in younger female triathletes. This study examined LV systolic function prior to, during and immediately following PSE (i.e., 40 km bicycle time trial followed by a 10 km run) in 13 younger (29 PlusMinus; 6 years) female triathletes. METHODS: Two-dimensional echocardiographic images were obtained prior to, at 30-minute intervals during and immediately following PSE. Heart rate, systolic blood pressure, end-diastolic and end-systolic cavity areas were measured at each time point. Echocardiographic and hemodynamic measures were also combined to obtain LV end-systolic wall stress and myocardial contractility (i.e., systolic blood pressure - end-systolic cavity area relation). RESULTS: Subjects exercised at an intensity equivalent to 90 PlusMinus; 3% of maximal heart rate. Heart rate, systolic blood pressure, systolic blood pressure - end-systolic cavity area relation and fractional area change increased while end-diastolic and end-systolic cavity areas decreased during exertion. CONCLUSIONS: PSE is associated with enhanced LV systolic function secondary to an increase in myocardial contractility in younger female triathletes.     

Acute effects of stretching exercise on the heart rate variability in subjects with low flexibility levels

The study investigated the heart rate (HR) and heart rate variability (HRV) before, during, and after stretching exercises performed by subjects with low flexibility levels. Ten men (age: 23 ± 2 years; weight: 82 ± 13 kg; height: 177 ± 5 cm; sit-and-reach: 23 ± 4 cm) had the HR and HRV assessed during 30 minutes at rest, during 3 stretching exercises for the trunk and hamstrings (3 sets of 30 seconds at maximum range of motion), and after 30 minutes postexercise. The HRV was analyzed in the time ('SD of normal NN intervals' [SDNN], 'root mean of the squared sum of successive differences' [RMSSD], 'number of pairs of adjacent RR intervals differing by >50 milliseconds divided by the total of all RR intervals' [PNN50]) and frequency domains ('low-frequency component' [LF], 'high-frequency component' [HF], LF/HF ratio). The HR and SDNN increased during exercise (p < 0.03) and decreased in the postexercise period (p = 0.02). The RMSSD decreased during stretching (p = 0.03) and increased along recovery (p = 0.03). At the end of recovery, HR was lower (p = 0.01), SDNN was higher (p = 0.02), and PNN50 was similar (p = 0.42) to pre-exercise values. The LF increased (p = 0.02) and HF decreased (p = 0.01) while stretching, but after recovery, their values were similar to pre-exercise (p = 0.09 and p = 0.3, respectively). The LF/HF ratio increased during exercise (p = 0.02) and declined during recovery (p = 0.02), albeit remaining higher than at rest (p = 0.03). In conclusion, the parasympathetic activity rapidly increased after stretching, whereas the sympathetic activity increased during exercise and had a slower postexercise reduction. Stretching sessions including multiple exercises and sets acutely changed the sympathovagal balance in subjects with low flexibility, especially enhancing the postexercise vagal modulation.     

Thermoregulatory and metabolic responses to repeated bouts of prolonged cycle-ergometer exercise in man

Changes in body temperature, oxygen uptake (VO2), heart rate (HR), sweating rate and plasma osmolarity were examined in 10 human subjects, performing four successive 30 min exercise-bouts of the same intensity (50% VO2 max) separated by 30 min rest periods. In spite of the rest intervals and replacement of body fluid loss there was a progressive increase in VO2. HR, rectal (Tre) and mean body (Tb) temperatures in consecutive exercise bouts. The thermoregulatory efficiency showed an increasing tendency, and a delay in the sweating response at the beginning of each exercise was shortened. It is concluded that a drift in metabolic and temperature responses to exercise, reported throughout a long-term continuous work, occurs also in the euhydrated subjects performing a prolonged intermittent exercise. It is not caused by an impaired thermoregulation during exercise but rather by insufficient restitution of metabolic processes during rest intervals.