Differing mechanisms of exercise flow augmentation at the mitral and aortic valves.

To determine the mechanisms by which blood flow increases across the mitral and aortic valves during exercise, 18 normal men were studied during graded supine and upright bicycle exercise at matched workloads. Mitral valve orifice and ascending aortic blood velocities were recorded by Doppler echocardiography during steady states at each stage of exercise. Parasternal two-dimensional echocardiographic imaging of the ascending aorta adjacent to the aortic valve orifice and the mitral valve orifice at the tips of the valve leaflets was used to calculate changes in cross-sectional area during exercise. Heart rate increased from rest to exercise from 67 to 150 beats/min (124%) during supine exercise and from 72 to 147 beats/min (104%) during upright exercise. Stroke volume increased 20% during supine and 46% during upright exercise; the increase in stroke volume was statistically significant when rest and exercise were compared and when the magnitude of change was compared vs position (p less than .05). The increase in stroke volume measured at the ascending aorta was accomplished by an increase in the velocity-time integral (+15% supine and +48% upright, p less than .05), with little change in aortic cross-sectional area (5% supine and 0% upright, p = NS). By contrast, the increase in flow rate measured at the mitral valve was predominantly due to an increase in mean diastolic cross-sectional area (+29% supine and 34% upright, p less than .05); the velocity-time integral did not increase significantly (-10% supine and 4% upright; p = NS).(ABSTRACT TRUNCATED AT 250 WORDS)