Changes in left ventricular function during recovery from upright bicycle exercise in normal persons and patients with coronary artery disease

To characterize the hemodynamic changes during recovery after upright bicycle exercise, 56 normal subjects (group I) and 30 patients with documented myocardial ischemia (group II) were studied. Heart rate, blood pressure and radionuclide angiographically determined absolute left ventricular (LV) volumes were measured at baseline, peak exercise and 2 to 4.5 minutes and 4.5 to 7 minutes after upright bicycle exercise. Whereas ejection fraction and end-systolic volume responses at peak exercise differed between groups I and II, these parameters showed similar trends in both groups during recovery. Mean ejection fraction increased during 2 to 4.5 minutes in both groups, but remained elevated during 4.5 to 7 minutes only in normal subjects (group I)- Elevation of cardiac output after exercise was accounted for predominantly by increased heart rate rather than increased stroke volume. Despite significantly decreased end-diastolic volume during recovery, stroke volume was maintained in both groups by a substantial decrease in end-systolic volume, suggesting the impact of decreased afterload or increased sympathetic tone during recovery. Thus, the Frank-Starling mechanism does not appear to be playing a major role during recovery after upright bicycle exercise, whereas enhanced contractility is evident in both normal subjects and patients with documented myocardial ischemia.