EXERTIONAL HEMODYNAMICS IN WOMEN WITH CHEST PAIN - AN AORTIC DOPPLER ULTRASOUND STUDY

Aortic ultrasound Doppler recordings of stroke volume, maximal flow ve locity, and acceleration can be used to assess central hemodynamic eff ects of exercise in coronary artery disease (CAD) and left ventricular dysfunction. We wanted to evaluate the time course and amplitude of c hanges in aortic Doppler ultrasound parameters in women during supine exercise and the potential diagnostic value of a submaximal supine exe rcise test. For this purpose, 18 women who had undergone coronary angi ography because of incapacitating chest pain (10 with significant coro nary stenoses and previous myocardial infarction, 8 without stenoses o r infarction) were compared with 10 healthy controls. Pathological ele ctrocardiographic (ECG) ST-segment depression during supine exercise w as common in all groups. In the control group, a significant increase of stroke volume (10%), maximal aortic flow velocity (27%), and accele ration (43%) occurred at low load during exercise. Women with CAD show ed no increase and a lower cardiac output during exercise, indicating left ventricular dysfunction. Women with syndrome X resembled the cont rols but had a higher maximal flow velocity at rest, which may indicat e hyperdynamic circulation. We conclude that a test up to 40% of seate d maximal load is valuable and often sufficient when assessing the hem odynamic effects of supine exercise by Doppler ultrasound in terms of stroke volume, maximal flow velocity, and acceleration. By characteriz ing left ventricular function in groups of female patients where false -positive stress ECG reactions are common, Doppler ultrasound may cont ribute to the understanding and clinical management of women with ches t pain.