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

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.