Circulation, Vol 84, 1016-1023, Copyright © 1991 by American Heart Association
BD Levine, LD Lane, JC Buckey, DB Friedman and CG Blomqvist
BACKGROUND. Endurance athletes have a high incidence of orthostatic
intolerance. We hypothesized that this is related to an abnormally large
decrease in left ventricular end-diastolic volume (LVEDV) and stroke volume
(SV) for any given decrease in filling pressure. METHODS AND RESULTS. We
measured pulmonary capillary wedge (PCW) pressure (Swan- Ganz catheter),
LVEDV (two-dimensional echocardiography), and cardiac output (C2H2
rebreathing) during lower body negative pressure (LBNP, - 15 and -30 mm Hg)
and rapid saline infusion (15 and 30 ml/kg) in seven athletes and six
controls (VO2max, 68 +/- 7 and 41 +/- 4 ml/kg/min). Orthostatic tolerance
was determined by progressive LBNP to presyncope. Athletes had steeper
slopes of their SV/PCW pressure curves than nonathletes (5.5 +/- 2.7 versus
2.7 +/- 1.5 ml/mm Hg, p less than 0.05). The slope of the steep, linear
portion of this curve correlated significantly with the duration of LBNP
tolerance (r = 0.58, p = 0.04). The athletes also had reduced chamber
stiffness (increased chamber compliance) expressed as the slope (k) of the
dP/dV versus P relation (chamber stiffness, k = 0.008 +/- 0.004 versus
0.031 +/- 0.004, p less than 0.005; chamber compliance, 1/k = 449.8 +/-
283.8 versus 35.3 +/- 4.3). This resulted in larger absolute and relative
changes in end- diastolic volume over an equivalent range of filling
pressures. CONCLUSIONS. Endurance athletes have greater ventricular
diastolic chamber compliance and distensibility than nonathletes and thus
operate on the steep portion of their Starling curve. This may be a
mechanical, nonautonomic cause of orthostatic intolerance.
ARTICLES
Left ventricular pressure-volume and Frank-Starling relations in endurance athletes. Implications for orthostatic tolerance and exercise performance
University of Texas Southwestern Medical Center, Dallas 75235-9034.
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