Comparison of the cardiac output and stroke volume response to upright exercise in children with valvular and subvalvular aortic stenosis
Cardiac output and stroke volume were evaluated in 17 children (mean age 11.5 ± 3 years) with discrete, membranous subvalvular (Group I, n = 7) and valvular (Group II, n = 10) aortic stenosis during submaximal and maximal (>75% predicted maximal oxygen consumption) upright cycle ergometry. Patien...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1988-03, Vol.11 (3), p.651-658 |
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| creator | Cyran, Stephen E. James, Frederick W. Daniels, Stephen Mays, Wayne Shukla, Rakesh Kaplan, Samuel |
| description | Cardiac output and stroke volume were evaluated in 17 children (mean age 11.5 ± 3 years) with discrete, membranous subvalvular (Group I, n = 7) and valvular (Group II, n = 10) aortic stenosis during submaximal and maximal (>75% predicted maximal oxygen consumption) upright cycle ergometry. Patients with valvular aortic stenosis were further subdivided on the basis of their aortic valve gradient at rest determined by cardiac catheterization (Group IIA, gradient |
| doi_str_mv | 10.1016/0735-1097(88)91545-8 |
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Stroke volume index in Group I was significantly greater at rest when compared with that in control subjects (69 ± 13 versus 53 ± 11 ml/m2, α = 0.01, p < 0.05) and that in patients in Group II (69 ± 13 versus 47 ± 12 ml/m2, α = 0.01, p < 0.05). Patients with subvalvular aortic stenosis were unable to increase their stroke volume index from rest to submaximal exercise and also decreased their stroke volume index at maximal exercise levels. In contrast, patients with mild valvular aortic stenosis (Group IIA) displayed a normal exercise response. Patients with severe valvular aortic stenosis (Group IIB) had a blunted stroke volume response at rest and at each level of exercise, as well as signs of myocardial ischemia (ST segment depression) during maximal exercise.
Cardiac output measurements during exercise testing permitted analysis of stroke volume patterns that differ by anatomic type and severity of left ventricular outflow tract obstruction. These findings have implications regarding the timing of treatment and exercise prescription for children with aortic stenosis.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/0735-1097(88)91545-8</identifier><identifier>PMID: 3343467</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Aortic Stenosis, Subvalvular - congenital ; Aortic Stenosis, Subvalvular - physiopathology ; Aortic Valve Stenosis - congenital ; Aortic Valve Stenosis - physiopathology ; Biological and medical sciences ; Cardiac Catheterization ; Cardiac Output ; Cardiology. Vascular system ; Cardiomyopathy, Hypertrophic - physiopathology ; Child ; Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava ; Echocardiography ; Exercise Test ; Heart ; Heart Rate ; Humans ; Medical sciences ; Posture ; Retrospective Studies ; Stroke Volume</subject><ispartof>Journal of the American College of Cardiology, 1988-03, Vol.11 (3), p.651-658</ispartof><rights>1988</rights><rights>1988 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c386t-6beae27a8703fd4c81de7aad51c67534fb3202cfa7600e48f5cbb593dc304dfd3</citedby><cites>FETCH-LOGICAL-c386t-6beae27a8703fd4c81de7aad51c67534fb3202cfa7600e48f5cbb593dc304dfd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/0735109788915458$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=7570624$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/3343467$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cyran, Stephen E.</creatorcontrib><creatorcontrib>James, Frederick W.</creatorcontrib><creatorcontrib>Daniels, Stephen</creatorcontrib><creatorcontrib>Mays, Wayne</creatorcontrib><creatorcontrib>Shukla, Rakesh</creatorcontrib><creatorcontrib>Kaplan, Samuel</creatorcontrib><title>Comparison of the cardiac output and stroke volume response to upright exercise in children with valvular and subvalvular aortic stenosis</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>Cardiac output and stroke volume were evaluated in 17 children (mean age 11.5 ± 3 years) with discrete, membranous subvalvular (Group I, n = 7) and valvular (Group II, n = 10) aortic stenosis during submaximal and maximal (>75% predicted maximal oxygen consumption) upright cycle ergometry. Patients with valvular aortic stenosis were further subdivided on the basis of their aortic valve gradient at rest determined by cardiac catheterization (Group IIA, gradient <40 mm Hg; Group IIB, gradient ≥ 40 mm Hg). These patients were matched with 17 control subjects on the basis of age, sex, height and intensity of exercise during maximal exertion. Cardiac and stroke indexes were determined by the acetylene rebreathing method at each exercise level.
Stroke volume index in Group I was significantly greater at rest when compared with that in control subjects (69 ± 13 versus 53 ± 11 ml/m2, α = 0.01, p < 0.05) and that in patients in Group II (69 ± 13 versus 47 ± 12 ml/m2, α = 0.01, p < 0.05). Patients with subvalvular aortic stenosis were unable to increase their stroke volume index from rest to submaximal exercise and also decreased their stroke volume index at maximal exercise levels. In contrast, patients with mild valvular aortic stenosis (Group IIA) displayed a normal exercise response. Patients with severe valvular aortic stenosis (Group IIB) had a blunted stroke volume response at rest and at each level of exercise, as well as signs of myocardial ischemia (ST segment depression) during maximal exercise.
Cardiac output measurements during exercise testing permitted analysis of stroke volume patterns that differ by anatomic type and severity of left ventricular outflow tract obstruction. These findings have implications regarding the timing of treatment and exercise prescription for children with aortic stenosis.</description><subject>Adolescent</subject><subject>Aortic Stenosis, Subvalvular - congenital</subject><subject>Aortic Stenosis, Subvalvular - physiopathology</subject><subject>Aortic Valve Stenosis - congenital</subject><subject>Aortic Valve Stenosis - physiopathology</subject><subject>Biological and medical sciences</subject><subject>Cardiac Catheterization</subject><subject>Cardiac Output</subject><subject>Cardiology. Vascular system</subject><subject>Cardiomyopathy, Hypertrophic - physiopathology</subject><subject>Child</subject><subject>Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava</subject><subject>Echocardiography</subject><subject>Exercise Test</subject><subject>Heart</subject><subject>Heart Rate</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Posture</subject><subject>Retrospective Studies</subject><subject>Stroke Volume</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1988</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kcuOFCEUholxMrajb6AJC2N0UQoFFNRmEtPxMskkbnRNKDjYaFVRcmnHR_CtrbY77W5WBM53_hy-g9AzSt5QQru3RDLRUNLLV0q97qngolEP0IYKoRomevkQbc7II_Q45--EkE7R_hJdMsYZ7-QG_dnGaTEp5Djj6HHZAbYmuWAsjrUstWAzO5xLij8A7-NYJ8AJ8hLnDLhEXJcUvu0KhjtINqxvYcZ2F0aXYMa_QtnhvRn3dTTpGFSH__eYSrBrNswxh_wEXXgzZnh6Oq_Q1w_vv2w_NbefP95s3902lqmuNN0ABlpplCTMO24VdSCNcYLaTgrG_cBa0lpvZEcIcOWFHQbRM2cZ4c47doVeHnOXFH9WyEVPIVsYRzNDrFlLRSlrBV1BfgRtijkn8Hr962TSb02JPmxAH_Tqg16tlP63Aa3Wtuen_DpM4M5NJ-Vr_cWpbrI1o09mXsWdMSkk6Vq-YtdHDFYX-wBJZxtgtuBCAlu0i-H-Of4CSeCmNw</recordid><startdate>19880301</startdate><enddate>19880301</enddate><creator>Cyran, Stephen E.</creator><creator>James, Frederick W.</creator><creator>Daniels, Stephen</creator><creator>Mays, Wayne</creator><creator>Shukla, Rakesh</creator><creator>Kaplan, Samuel</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19880301</creationdate><title>Comparison of the cardiac output and stroke volume response to upright exercise in children with valvular and subvalvular aortic stenosis</title><author>Cyran, Stephen E. ; James, Frederick W. ; Daniels, Stephen ; Mays, Wayne ; Shukla, Rakesh ; Kaplan, Samuel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c386t-6beae27a8703fd4c81de7aad51c67534fb3202cfa7600e48f5cbb593dc304dfd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1988</creationdate><topic>Adolescent</topic><topic>Aortic Stenosis, Subvalvular - congenital</topic><topic>Aortic Stenosis, Subvalvular - physiopathology</topic><topic>Aortic Valve Stenosis - congenital</topic><topic>Aortic Valve Stenosis - physiopathology</topic><topic>Biological and medical sciences</topic><topic>Cardiac Catheterization</topic><topic>Cardiac Output</topic><topic>Cardiology. Vascular system</topic><topic>Cardiomyopathy, Hypertrophic - physiopathology</topic><topic>Child</topic><topic>Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava</topic><topic>Echocardiography</topic><topic>Exercise Test</topic><topic>Heart</topic><topic>Heart Rate</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Posture</topic><topic>Retrospective Studies</topic><topic>Stroke Volume</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cyran, Stephen E.</creatorcontrib><creatorcontrib>James, Frederick W.</creatorcontrib><creatorcontrib>Daniels, Stephen</creatorcontrib><creatorcontrib>Mays, Wayne</creatorcontrib><creatorcontrib>Shukla, Rakesh</creatorcontrib><creatorcontrib>Kaplan, Samuel</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cyran, Stephen E.</au><au>James, Frederick W.</au><au>Daniels, Stephen</au><au>Mays, Wayne</au><au>Shukla, Rakesh</au><au>Kaplan, Samuel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparison of the cardiac output and stroke volume response to upright exercise in children with valvular and subvalvular aortic stenosis</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1988-03-01</date><risdate>1988</risdate><volume>11</volume><issue>3</issue><spage>651</spage><epage>658</epage><pages>651-658</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>Cardiac output and stroke volume were evaluated in 17 children (mean age 11.5 ± 3 years) with discrete, membranous subvalvular (Group I, n = 7) and valvular (Group II, n = 10) aortic stenosis during submaximal and maximal (>75% predicted maximal oxygen consumption) upright cycle ergometry. Patients with valvular aortic stenosis were further subdivided on the basis of their aortic valve gradient at rest determined by cardiac catheterization (Group IIA, gradient <40 mm Hg; Group IIB, gradient ≥ 40 mm Hg). These patients were matched with 17 control subjects on the basis of age, sex, height and intensity of exercise during maximal exertion. Cardiac and stroke indexes were determined by the acetylene rebreathing method at each exercise level.
Stroke volume index in Group I was significantly greater at rest when compared with that in control subjects (69 ± 13 versus 53 ± 11 ml/m2, α = 0.01, p < 0.05) and that in patients in Group II (69 ± 13 versus 47 ± 12 ml/m2, α = 0.01, p < 0.05). Patients with subvalvular aortic stenosis were unable to increase their stroke volume index from rest to submaximal exercise and also decreased their stroke volume index at maximal exercise levels. In contrast, patients with mild valvular aortic stenosis (Group IIA) displayed a normal exercise response. Patients with severe valvular aortic stenosis (Group IIB) had a blunted stroke volume response at rest and at each level of exercise, as well as signs of myocardial ischemia (ST segment depression) during maximal exercise.
Cardiac output measurements during exercise testing permitted analysis of stroke volume patterns that differ by anatomic type and severity of left ventricular outflow tract obstruction. These findings have implications regarding the timing of treatment and exercise prescription for children with aortic stenosis.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>3343467</pmid><doi>10.1016/0735-1097(88)91545-8</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals; EZB-FREE-00999 freely available EZB journals |
| subjects | Adolescent Aortic Stenosis, Subvalvular - congenital Aortic Stenosis, Subvalvular - physiopathology Aortic Valve Stenosis - congenital Aortic Valve Stenosis - physiopathology Biological and medical sciences Cardiac Catheterization Cardiac Output Cardiology. Vascular system Cardiomyopathy, Hypertrophic - physiopathology Child Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava Echocardiography Exercise Test Heart Heart Rate Humans Medical sciences Posture Retrospective Studies Stroke Volume |
| title | Comparison of the cardiac output and stroke volume response to upright exercise in children with valvular and subvalvular aortic stenosis |
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