Echocardiographic Diastolic Stress Testing: What Does It Add?

Purpose of Review: Diastolic stress echocardiography may help facilitate the attribution of exertional dyspnea to cardiac and non-cardiac disease. It represents a non-invasive hemodynamic test to assess the patients with unexplained dyspnea. It can improve the diagnosis of heart failure with preserved ejection fraction (HFpEF) or diastolic heart failure. Recent Findings: A number of studies have validated exercise E/e′ as a measure of left ventricular (LV) filling pressure against invasively measured LV filling pressure using simultaneous exercise echocardiography-catheterization studies. Addition of E/e′ during exercise echocardiography improved sensitivity for diagnosis of HFpEF compared with resting assessment alone, and its specificity can be improved if tricuspid regurgitation velocity also increases above the normal range with exercise. The independent prognostic value of exercise E/e′ has also been well delineated in a number of studies. Summary: Diastolic stress exercise echocardiography should be considered for all patients with unexplained or exertional dyspnea and normal diastolic filling pressure or grade 1 diastolic dysfunction on resting echocardiography. Addition of diastolic assessment with exercise echocardiography improves the sensitivity of the test in patients with dyspnea and there are sufficient data to integrate diastolic exercise test into our clinical practice.