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June 10, 2009

Exercise Capacity and Left Ventricular Function—Reply

JAMA. 2009;301(22):2325-2327. doi:10.1001/jama.2009.698

In Reply: In our population undergoing clinically indicated echocardiography, regional wall motion assessment postexercise was of primary importance and E/e′ was measured following this. As Drs Peteiro and Bouzas-Mosquera have suggested, the E/e′ measured at 2 to 7 minutes after cessation of exercise may provide somewhat different information compared with the E/e′ measured at peak exercise. Following maximal exercise, heart rate recovery follows an exponential curve, but the rate of recovery of ischemic regional wall motion abnormalities is variable and more gradual.1 Recently, postischemic abnormalities in regional left ventricular relaxation have been shown to have a delayed recovery after treadmill exercise.2 We think it is likely that even in patients without ischemia, exertional changes in diastolic function and filling pressures will not recover as quickly as the heart rate. The changes in diastolic function during recovery in our population of patients of varying ages and with various comorbidities who underwent maximal symptom-limited exercise likely differ from the changes observed in the young, trained volunteers who underwent low-intensity exercise in the study by Giannaki et al.3 Postexercise left ventricular inflow pattern was not assessed in our study but would also have been of interest.

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