BackgroundWe studied the effect of exercise (7.2 to 8.0 km/h) on the efficiency of the conversion of metabolic energy to external work or stroke work (SW) by the left ventricle (LV).Methods and ResultsEnergy use was calculated from LV myocardial oxygen consumption per beat (M&OV0622;O2). LV volume was calculated from orthogonal dimensions and coronary flow measured with ultrasonic flow probes. The total mechanical energy of the LV was calculated as the pressure-volume area (PVA). At rest, the M&OV0622;O2-PVA point fell on the M&OV0622;O2-PVA relation determined by steady-state changes in arterial pressure produced by graded infusions of phenylephrine. Exercise increased the slope (Ees) of LV end-systolic pressure-volume (PV) relation by 29%. During exercise, the M&OV0622;O2-PVA point shifted to the right only slightly above the control M&OV0622;O2-PVA relation by 0.007 ± 0.005 mL O2.beat−1.100 g LV−1. Despite the increase in ventricular contractility with exercise, the PVA/M&OV0622;O2ratio was unchanged because of the marked increase in PVA. During exercise, the transmission of total mechanical energy to external work (SW/PVA) increased from 65 ± 5% to 72 ± 4% (P< .01) as the ratio of the arterial end-systolic elastance to Eesdecreased from 1.1 ± 0.2 to 0.8 ± 0.1 (P< .05). Thus, LV mechanical efficiency (SW/M&OV0622;O2= SW/PVA.PVA/M&OV0622;O2) improved from 12.9 ± 1.5% to 14.3 ± 1.1% (P< .05) during exercise.ConclusionsExercise increases the efficiency of conversion of metabolic energy to external work by the LV due to alteration in LV arterial coupling resulting in increased production of mechanical energy and enhanced transmission of mechanical energy to external work, which more than offsets any increased metabolic cost of the enhanced contractility.