Left ventricular systolic dysfunction diastolic filling characteristics and exercise cardiac reserve in mitral stenosis

In summary, our data indicate that a significant number of patients with severe MS have LV systolic dysfunction. This results, at least in part, from diastolic flow reduction caused by the tight mitral valve and possibly by the poorly compliant LV posterior wall, which reduces LV end-diastolic volume. Although ejection fraction increases with exercise, LV filling is further compromised by the shorter diastolic periods at higher heart rates, resulting in a severe reduction in LV end-diastolic and stroke volumes, and an attenuated increase or actual decrease in cardiac output.