Carotid‐Ventricular Coupling During Exercise

Objectives To evaluate carotid elasticity and left ventricular elastance during a graded bicycle semisupine exercise test in patients with known or suspected coronary artery disease and compare them with a control group of healthy young volunteers. Methods Thirty‐six elderly patients and 18 young healthy volunteers were recruited. The right carotid diameter was estimated by an automatic system applied to B‐mode sonographic sequences, central mean blood and pulse pressures by radial artery tonometry, and cardiac volumes by 2‐dimensional transthoracic echocardiography; from these direct measurements, the carotid cross‐sectional distensibility coefficient and left ventricular elastance index were obtained. Analyses were performed at rest, at peak stress, and during the recovery phase. Results The elderly patients included 20 men (mean age ± SD, 61 ± 8 years); the volunteers included 9 men (mean age, 34 ± 3 years). The mean blood pressure (at rest: patients, 97 ± 7 mm Hg; controls, 93 ± 9 mm Hg; not significant) increased similarly in both groups during exercise and decreased during the recovery phase. The diameter was higher in patients than controls (7.5 ± 1.1 versus 6.2 ± 0.5 mm) and increased significantly with exercise only in the latter group (at peak: 6.5 ± 0.6 mm; P < .05). The distensibility coefficient and elastance index were lower in patients than controls during the test phases [at rest: 24.5 ± 10.2 versus 60.8 ± 21.3 × 10 −3 /kPa and 3.6 ± 1.4 versus 1.6 ± 0.8 mm Hg/(mL/m 2 )] and mostly changed in the controls, showing a decreased distensibility coefficient (peak: 40.6 ± 15.1 × 10 −3 /kPa) and an increased elastance index [peak: 5.9 ± 2.8 mm Hg/(mL/m 2 )]. Conclusions In older patients with multiple cardiovascular risk factors or established coronary artery disease, an abnormal carotid‐ventricular adaptation to exercise was observed when compared to young healthy individuals.