TY - JOUR
T1 - Diastolic stress echocardiography
T2 - A novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography
AU - Ha, Jong Won
AU - Oh, Jae K.
AU - Pellikka, Patricia A.
AU - Ommen, Steve R.
AU - Stussy, Vicky L.
AU - Bailey, Kent R.
AU - Seward, James B.
AU - Tajik, A. Jamil
N1 - Funding Information:
Supported by postdoctoral fellowship grant 0120622Z from the American Heart Association, Northland Affiliate (Dr Ha).
PY - 2005/1
Y1 - 2005/1
N2 - Left ventricular filling pressures can be estimated reliably by combining mitral inflow early diastolic velocity (E) and annulus velocity (E′). An increased E/E′ ratio reflects elevated filling pressures and may be useful in assessing an abnormal increase in filling pressures for patients with diastolic dysfunction. The purpose of this study was to evaluate the feasibility of supine bicycle exercise Doppler echocardiography for assessing left ventricular diastolic pressure during exercise. Mitral inflow and septal mitral annulus velocities were measured at rest and during supine bicycle exercise (25-W 3-minute increments) in 45 patients (19 men; mean age, 59 years) referred for evaluation of exertional dyspnea. None had echocardiographic or electrocardiographic evidence of myocardial ischemia with exercise. Patients were classified according to E/E′ ratio at rest: 26 had E/E′ ≤ 10 at rest (group 1) and 19 had E/E′ > 10 (group 2). For group 1, 17 had no increase in E/E′ during exercise (group 1A) and 9 did (group 1B). For group 2, E/E′ did not increase during exercise. Despite different responses of E/E′, there was no significant difference in changes of mitral inflow indices (E, A, E/A, deceleration time) between groups. Although the percentage of dyspnea as a primary reason for stopping exercise was similar for the groups, exercise duration was significantly shorter for groups 1B (7.2 ± 2.5 minutes) and 2 (7.1 ± 3.3 minutes) than in group 1A (10.4 ± 3.7 minutes, P =. 0129). Diastolic stress echocardiography using a supine bicycle is technically feasible for demonstrating changes in E/E′ (filling pressure) with exercise. Our preliminary results suggest the hemodynamic consequences of exercise-induced increase in diastolic filling pressure can be demonstrated noninvasively with exercise Doppler echocardiography.
AB - Left ventricular filling pressures can be estimated reliably by combining mitral inflow early diastolic velocity (E) and annulus velocity (E′). An increased E/E′ ratio reflects elevated filling pressures and may be useful in assessing an abnormal increase in filling pressures for patients with diastolic dysfunction. The purpose of this study was to evaluate the feasibility of supine bicycle exercise Doppler echocardiography for assessing left ventricular diastolic pressure during exercise. Mitral inflow and septal mitral annulus velocities were measured at rest and during supine bicycle exercise (25-W 3-minute increments) in 45 patients (19 men; mean age, 59 years) referred for evaluation of exertional dyspnea. None had echocardiographic or electrocardiographic evidence of myocardial ischemia with exercise. Patients were classified according to E/E′ ratio at rest: 26 had E/E′ ≤ 10 at rest (group 1) and 19 had E/E′ > 10 (group 2). For group 1, 17 had no increase in E/E′ during exercise (group 1A) and 9 did (group 1B). For group 2, E/E′ did not increase during exercise. Despite different responses of E/E′, there was no significant difference in changes of mitral inflow indices (E, A, E/A, deceleration time) between groups. Although the percentage of dyspnea as a primary reason for stopping exercise was similar for the groups, exercise duration was significantly shorter for groups 1B (7.2 ± 2.5 minutes) and 2 (7.1 ± 3.3 minutes) than in group 1A (10.4 ± 3.7 minutes, P =. 0129). Diastolic stress echocardiography using a supine bicycle is technically feasible for demonstrating changes in E/E′ (filling pressure) with exercise. Our preliminary results suggest the hemodynamic consequences of exercise-induced increase in diastolic filling pressure can be demonstrated noninvasively with exercise Doppler echocardiography.
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U2 - 10.1016/j.echo.2004.08.033
DO - 10.1016/j.echo.2004.08.033
M3 - Article
C2 - 15637491
AN - SCOPUS:11144239323
SN - 0894-7317
VL - 18
SP - 63
EP - 68
JO - Journal of the American Society of Echocardiography
JF - Journal of the American Society of Echocardiography
IS - 1
ER -