Letters |

Exercise Capacity and Left Ventricular Function—Reply

Jasmine Grewal, MD; Carolyn Lam, MD; Patricia A. Pellikka, MD
JAMA. 2009;301(22):2325-2327. doi:10.1001/jama.2009.698.
Text Size: A A A
Published online


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.


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




June 10, 2009
Jesús Peteiro, MD, PhD; Alberto Bouzas-Mosquera, MD
JAMA. 2009;301(22):2325-2327. doi:10.1001/jama.2009.696.
June 10, 2009
Ali Gharavi, MD; Joseph A. Diamond, MD; Robert A. Phillips, MD, PhD
JAMA. 2009;301(22):2325-2327. doi:10.1001/jama.2009.697.
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.