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We performed dual M-mode exercise echocardiography, which records left ventricular (LV) and left atrial (LA) echocardiograms simultaneously, in 10 normal subjects to investigate mechanisms of cardiac adaptation to dynamic exercise. The LV end-diastolic dimension (EDD) increased significantly as exercise increased from mild to moderate (3-5%, p less than 0.05 and 0.001). At peak exercise the EDD was slightly increased, but it returned to the baseline during recovery. The LV end-systolic dimension (ESD) showed a progressive decrease with the severity of exercise (5-13%, p less than 0.05 and 0.001). It decreased further immediately after exercise (17-20%) and then returned to the resting value. The LV stroke dimension and fractional shortening increased as exercise changed from mild to moderate and reached a plateau at peak exercise. During recovery, they showed a transient increase and then decreased. By contrast, the LA dimensions, both maximum and minimum, increased significantly as exercise changed from mild to moderate (15-16% and 16-19%, p less than 0.01 and 0.001, respectively), but they were lower at peak exercise (12 and 14%). They returned rapidly to the resting values immediately after exercise. Thus, during exercise, LV function is augmented by the Frank-Starling mechanism in combination with increased contractility, while the LA is enlarged to receive the increased venous return accompanying dynamic exercise. These exercise-induced changes in LV performance return gradually to the resting state, but LA size recovers rapidly after the cessation of exercise.

Simultaneous changes of left ventricular and left atrial size and function in normal subjects during exercise.