Exercise-induced changes in left ventricular filling pressure after myocardial infarction assessed with simultaneous right heart catheterization and Doppler echocardiography

Mads J. Andersen, Mads Ersbøll, Finn Gustafsson, Anna Axelsson, Christian Hassager, Lars Køber, Søren Boesgaard, Patricia A. Pellikka, Jacob E. Møller

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Abstract

Background To assess whether changes in E/é (the ratio between peak early mitral inflow velocity (E) and peak early mitral annulus velocity (é)) during exercise reflect changes in filling pressure in patients with a recent myocardial infarction (MI) and mild to moderate diastolic dysfunction at rest. A low E/é ratio is associated with low filling pressures while a high E/é ratio is associated with high filling pressures. In the intermediate range of E/é guidelines suggest additional measurements during exercise in order to determine filling pressures. Methods and results Sixty-one patients with a recent MI and left ventricular ejection fraction (LVEF) ≥ 45%, left atrium (LA) > 34 ml/m2 and E/é between 8 and 15, underwent simultaneous right heart catheterization and Doppler echocardiography during a symptom limited semi supine cycle exercise test. E velocity increased from 75 ± 16 to 139 ± 27 cm/s and é increased from 7.1 ± 1.4 to 16.1 ± 3.6 cm/s with exercise. Thus, E/é decreased from 10.5 ± 1.7 to 9.3 ± 2.3 while pulmonary capillary wedge pressure (PCWP) increased from 13 ± 4 to 33 ± 8 mmHg. There was no correlation between LV filling pressure and E/é at rest, at 4 METS, at peak exercise or 5 min after termination of exercise. Neither was there any correlation between changes in PCWP and changes in E/é. Conclusion For post-MI patients with resting E/é in the intermediate range changes in E/é with physical exercise does not reflect changes in LV filling pressures.

Original languageEnglish (US)
Pages (from-to)2803-2810
Number of pages8
JournalInternational Journal of Cardiology
Volume168
Issue number3
DOIs
StatePublished - Oct 3 2013

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Keywords

  • Exercise
  • Heart catheterization
  • Myocardial infarction
  • Stress echocardiography
  • Ventricular diastolic dysfunction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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