Effects of exercise on left ventricular filling dynamics

Changes in left ventricular pressure (LVP), left atrial pressure changes (LAP), and the rate of change of LVP (dV/dt) at rest and during exercise.
(Top panel) During exercise in normals, minimal LVP decreases without any change in LAP, leading to an increase in the peak mitral valve gradient and producing a higher peak filling rate (E).
(Bottom panel) In heart failure, the peak LV filling rate (E) increases during exercise due to an increase in the early transmitral valve pressure gradient. However, the gradient is produced by an increase in left atrial pressure instead of a reduction in LVP as occurs in normals.