Assessment of Diastolic Function During Exercise Echocardiography: Annulus Mitral Velocity or Transmitral Flow Pattern?

Peteiro, Jesús; Pazos, Pablo; Bouzas, Alberto; Piñón, Pablo; Estevez, R; Castro‐Beiras, Alfonso

doi:10.1016/j.echo.2007.06.009

Cited by 20 publications

(16 citation statements)

References 16 publications

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“…[1][2][3][4][5][6] Despite data demonstrating the value of evaluating diastolic function during stress, 7 left ventricular diastolic function is routinely assessed at rest even in patients with exertional symptoms. This association between diastolic dysfunction and exertional symptoms is independent of left ventricular systolic function and has been demonstrated in patients with both normal and abnormal systolic function.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Despite the presence of exertional symptoms and data demonstrating the value of evaluating diastolic function during stress, 7 left ventricular diastolic function is routinely assessed at rest, rather than during stress. [1][2][3][4][5][6] Despite the presence of exertional symptoms and data demonstrating the value of evaluating diastolic function during stress, 7 left ventricular diastolic function is routinely assessed at rest, rather than during stress.…”

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confidence: 99%

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Real Time Three-Dimensional Stress Echocardiography: A New Approach for Assessing Diastolic Function

et al. 2011

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Real Time Three-Dimensional Stress Echocardiography: A New Approach for Assessing Diastolic Function

et al. 2011

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“…Using a combination of transmitral filling and peak annular diastolic velocity at rest and post exercise in 179 patients referred for exercise echocardiography, exercise capacity was reduced in patients with impaired relaxation at rest and post exercise if there was an E/e’ > 11. Otherwise, a restrictive filling pattern at rest or post exercise resulted in reduced exercise capacity [12]. …”

Section: Discussionmentioning

confidence: 99%

Exercise Tolerance and the Post Exercise Diastolic Filling Pattern in Patients With the Resting Impaired Relaxation

Lavine

2011

Cardiol Res

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BackgroundIn patients with normal LV systolic function, cardiac output increases with exercise mediated by increased stroke volume early in exercise and an increase in heart rate later in exercise. Despite normal LV systolic function, patients who display an impaired relaxation pattern may have a reduced exercise tolerance. We hypothesized that the resting impaired relaxation pattern that persists during exercise results in reduced LV filling volume and reduced exercise tolerance.MethodsWe evaluated consecutive exercise echocardiograms performed at Harper Hospital from 1998-2000 for patients with sinus rhythm, normal resting wall motion and ejection fraction (> 55%), evidence of resting impaired relaxation, and a negative exercise echocardiogram. There were 49 patients fitting the above criteria who were compared with a group of age and sex matched patients (43 patients) with a normal rest and exercise echocardiogram with normal resting transmitral Doppler. Rest and post exercise echocardiography and Doppler parameters were obtained.ResultsPatients in the impaired relaxation group demonstrated shorter exercise times as compared to the normal control group (8.8 ± 1.6 versus 9.7 ± 2.0 minutes, P < 0.001). In patients with normal resting transmitral diastolic filling, there was an increased the extent of atrial contribution to LV filling volume post exercise associated with shortening of isovolumic relaxation. Two patterns were seen in the impaired relaxation group post exercise. In 1 subgroup in which E/A ratio decreased post exercise, exercise duration was reduced (7.4 ± 1.3 minutes, P < 0.001) as compared to the subgroup with E/A increase (9.6 ± 1.2 minutes) post exercise which was similar to normal controls. Forward stepwise regression indicated that exercise time was primarily related to E/A change post exercise for all patient groups (r = 0.625, P = 0.0008). Specifically, this was true for patients with E/A reversal at rest (r = 0.584, P = 0.0028). However, for patients with normal diastolic filling at rest, the diastolic velocity integral was the major predictor (r = 0.695, P < 0.0084).ConclusionWe conclude that the transmitral Doppler pattern post exercise provides insight into the mechanism of reduced exercise tolerance in some patients with the resting impaired relaxation pattern. Preservation of this pattern post exercise is associated with reduced exercise tolerance.

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“…Among the numerous indices of diastolic function, the ratio of early transmitral flow assessed by pulsed Doppler (E) to early diastolic annulus velocity assessed by tissue Doppler (é) is closely related to LV end-diastolic pressure and can be easily measured during ESE. A higher E/é ratio index is associated with the presence of dyspnea, lower functional capacity, exercise-induced LV dysfunction and CAD [5,45] . A change to a pseudonormalized LV inflow pattern during exercise is also associated with the same poor prognostic indicators [45] .…”

Section: Exercise Echocardiography: From the Evaluation Of Chest Painmentioning

confidence: 99%

“…A higher E/é ratio index is associated with the presence of dyspnea, lower functional capacity, exercise-induced LV dysfunction and CAD [5,45] . A change to a pseudonormalized LV inflow pattern during exercise is also associated with the same poor prognostic indicators [45] . These measurements, along with the assessment of pulmonary artery pressure during exercise, may help to clarify causes of dyspnea in patients with different cardiac or noncardiac conditions.…”

Section: Exercise Echocardiography: From the Evaluation Of Chest Painmentioning

confidence: 99%

Exercise echocardiography

Peteiro

Bouzas‐Mosquera²

2010

WJC

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Exercise echocardiography has been used for 30 years. It is now considered a consolidated technique for the diagnosis and risk stratification of patients with known or suspected coronary artery disease (CAD). Of the stress echocardiography techniques, it represents the first choice for patients who are able to exercise. Given that the cost-effectiveness and safety of stress echocardiography are higher than those of other imaging techniques, its use is likely to be expanded further. Recent research has also proposed this technique for the evaluation of cardiac pathology beyond CAD. Although the role of new technology is promising, the assessment of cardiac function relies on good quality black and white harmonic images.

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Assessment of Diastolic Function During Exercise Echocardiography: Annulus Mitral Velocity or Transmitral Flow Pattern?

Cited by 20 publications

References 16 publications

Real Time Three-Dimensional Stress Echocardiography: A New Approach for Assessing Diastolic Function

Real Time Three-Dimensional Stress Echocardiography: A New Approach for Assessing Diastolic Function

Exercise Tolerance and the Post Exercise Diastolic Filling Pattern in Patients With the Resting Impaired Relaxation

Exercise echocardiography

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