Evidence of frank-starling effect in man during severe semisupine exercise.

Abstract

Studies in man produce conflicting evidence of the role of the Frank-Starling mechanism in increasing cardiac output during exercise, though animal studies indicate that cardiac performance can be improved during severe exertion. Healthy volunteers (12, mean age 35.8 .+-. 2.8 yr) performed graded exercise to exhaustion on a bicycle ergometer in the semisupine position for 8.9 .+-. 0.9 min (maximum work load 900 kg-m/min). Echocardiographic recordings of left ventricular dimensions were obtained continuously and end-expiratory tracings digitized. Heart rate increased from 64 .+-. 3 to 152 .+-. 4 beats/min. At peak exercise, end-diastolic diameter increased from 4.52 .+-. 0.20 to 5.24 .+-. 0.17 cm (P < 0.001), but was unchanged at lower heart rates of 90 and 110 beats/min. End-systolic diameter did not change at any heart rate. Stroke dimension (end-diastolic minus end-systolic diameter) increased from 1.77 .+-. 0.14 to 2.50 .+-. 0.11 cm (P < 0.005), but was unchanged at lower levels of exercise. Percent shortening in diameter rose from 38.8 .+-. 1.7 at rest to 48.0 .+-. 2.1% at peak exercise (P < 0.01), increasing to 43.0 .+-. 2.5% at 110 beats/min (P < 0.05). Mean velocity of circumferential shortening increased with progressively higher heart rates from its resting value of 5.05 .+-. 0.49 cm/s to 9.37 .+-. 0.77 cm/s at peak exercise (P < 0.0005). Velocity of circumferential shortening normalized for end-diastolic diameter increased progressively, from 1.10 .+-. 0.09/s at rest to 1.87 .+-. 0.17/s at peak exercise (P < 0.0005). Maximum rates of change in diameter in systole and diastole and normalized maximum diastolic rate of change all increased progressively and significantly throughout the exercise period. Severe semisupine exertion may cause an increase in left ventricular end-diastolic diameter, stroke dimension and percent change in diameter, but no change in end-systolic diameter measured at end-expiration. Increases in indices of left ventricular fiber shortening and rates of lengthening appear earlier in exercise than an increase in end-diastolic fiber length, suggesting that during lower levels of exertion cardiac output rises primarily by increases in heart rate. The Frank-Starling effect appears to be reserved for augmenting cardiac performance during severe semisupine exertion.