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Insights of pressure–flow relationship during exercise in cardiovascular diseases
  1. Kenya Kusunose
  1. Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
  1. Correspondence to Dr Kenya Kusunose, Cardiovascular Medicine, Tokushima University Hospital, Tokushima 770-8503, Japan; kusunosek{at}

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Exercise right heart catheterisation can help identify haemodynamic variations that reflect impaired cardiac or pulmonary vascular function, which are not clear at rest. Haemodynamic response patterns during exercise may also assess the severity of cardiovascular diseases, which can help to improve the management of the conditions.1 Andersen et al reported on the invasive haemodynamic data during exercise of 168 subjects, who either had pressure overload from aortic stenosis (AS), volume overload from mitral regurgitation (MR), myocardial impairment from acute myocardial infarction (AMI) or were healthy.2 This study included a wide variety of patients, asymptomatic moderate to severe AS, moderate to severe MR with preserved EF (ejection fraction), and patients after AMI with diastolic dysfunction (large left atrial size and elevated E/e’) and preserved EF. The authors focused on the haemodynamic variation of the pressure–flow relationship, based on the association between the change in cardiac output (CO) and pulmonary artery wedge pressure (PAWP)/mean pulmonary artery pressure (mPAP), in these groups. As a result of invasive exercise testing, the authors identified different pressure–flow relationships in these groups.

The pressure–flow relationship is well known as the ventricular curve or the Frank-Starling relationship.3 The Frank-Starling curves reflect the response of the ventricle pump function to various loading conditions. In healthy subjects, there is a steep inclination between cardiac filling pressure (as estimated from the PAWP) and CO. However, in subjects with cardiac failure, this inclination is flattened, leading to continued increases of PAWP with only small …

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  • Contributors KK is the sole contributor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note The Corresponding Author has the right to grant and does grant, an exclusive license on a worldwide basis to the BMJ Publishing Group and its Licensees to permit this article to be published in Heart editions and any other BMJPGL products to exploit all subsidiary rights.

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