Left Ventricular Diastolic Filling Pressures During Dobutamine Stress Echocardiography: Relationship to Symptoms and Ischemia

Nakajima, Yoshie; Kane, Garvan C.; McCully, Robert B.; Ommen, Steve R.; Pellikka, Patricia A.

doi:10.1016/j.echo.2009.04.030

Cited by 21 publications

(16 citation statements)

References 30 publications

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“…Another study performed on 219 patients by Nakajima et al . [11] validated the importance of our observation. It demonstrated the evidence of an inverse correlation between the number of ischemic segments and peak s’ and e’ velocities; in other words, patients who developed dyspnea and angina had a lower e’ velocity at rest, during dobutamine SE and during recovery, and a higher E/e’ ratio compared with patients who did not develop ischemia.…”

Section: Discussionsupporting

confidence: 76%

Stress-induced worsening of left ventricular diastolic function as a marker of myocardial ischemia

Mansour

AlJaroudi

Mroueh

et al. 2017

J Cardiovasc Echography

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Background:Echocardiography has been the subject of interest in diagnosing diastolic dysfunction and estimating left ventricular filling pressures (LVFPs). The present study is set to estimate the correlation between the worsening of diastolic parameters and the evidence of inducible ischemia during an exercise stress echocardiography (SE) in comparison with the results of coronary computed tomographic angiogram (CCTA).Methods:A total of 191 consecutive patients from the executive screening program who underwent exercise SE followed by CCTA were evaluated. Baseline demographics, heart rate, and blood pressure measurements were extracted for analysis. Standard two-dimensional and tissue Doppler imaging parameters were analyzed. Diastolic function was graded at rest and peak exercise.Results:Patients who had worsening of diastolic function by at least one grade had had 2–3-fold higher odds of having abnormal SE. In addition, patients with worsening of diastolic function had higher stress LVFPs (E/e’ = 11.7 ± 2.7 vs. E/e’ 8.0 ± 2.0; P < 0.0001), more E/e’ change >25% (48% vs. 22%, P = 0.012), and were more likely to have obstructive coronary artery disease (CAD) on CCTA (23.8% vs. 9.2%; P = 0.045). A change in E/e’ >25% (stress-rest) was highly associated with a positive stress test and abnormal CCTA result. Patients with no change or improvement in diastolic function with stress had a 92% negative predictive value of having normal SE and 91% of normal/nonobstructive CCTA.Conclusion:A worsening of diastolic function and a change in E/e’ >25% (stress-rest) were associated with abnormal SE, positive stress test, and obstructive CAD when compared to CCTA results.

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Section: Discussionsupporting

confidence: 76%

Stress-induced worsening of left ventricular diastolic function as a marker of myocardial ischemia

Mansour

AlJaroudi

Mroueh

et al. 2017

J Cardiovasc Echography

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“…Furthermore, ischemia has the propensity to influence LV filling pressure, particularly with stress. 28 For these reasons, the current study is unique in demonstrating the independent prognostic value of exercise E/eЈ after accounting for the influence of inducible ischemia.…”

Section: Ischemiamentioning

confidence: 99%

Prognostic Implications of Left Ventricular Filling Pressure With Exercise

Holland

Prasad

Marwick

2010

Circ: Cardiovascular Imaging

102

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Background-The estimation of left ventricular (LV) filling pressure from the ratio of transmitral and annular velocities (E/eЈ) after exercise echocardiography may identify diastolic dysfunction in patients who complain of exertional dyspnea. This study sought to determine the relative contributions of exercise E/eЈ and ischemia to outcomes in patients referred for exercise echocardiography. Methods and Results-Rest and exercise E/eЈ were obtained in 522 patients referred for exercise echocardiography, who were followed for cardiovascular death and hospitalization over a median of 13.2 months. Exercise E/eЈ Ͼ2 SD from normal was used to denote raised LV filling pressure with stress (nϭ75), and ischemia (nϭ250) was identified by inducible wall motion abnormalities. There were 65 cardiovascular hospitalizations during the follow-up period. Survival analysis showed patients without ischemia and with normal exercise E/eЈ to have a better prognosis than those with ischemia, with or without raised exercise E/eЈ (Pϭ0.003) and the outcomes of patients with isolated raised exercise E/eЈ and isolated ischemia to be similar. Exercise E/eЈ was most valuable in patients with normal resting E/eЈ; those with elevation with exercise had a worse outcome than those with normal exercise E/eЈ (Pϭ0.014). Exercise capacity (hazard ratio, 0.893; Pϭ0.008), exercise wall motion score index (hazard ratio, 1.507; PϽ0.001), and exercise E/eЈ Ͼ14.5 (hazard ratio, 2.988; Pϭ0.002) were independent predictors of outcome. The addition of exercise E/eЈ to exercise capacity and wall motion score index resulted in an increment in model power to predict adverse outcome (Pϭ0.006). Conclusions-Exercise E/eЈ is associated with cardiovascular hospitalization, independent of and incremental to inducible ischemia. (Circ Cardiovasc Imaging. 2010;3:149-156.)

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“…There is extensive literature relating to the application of diastolic function evaluation to stress echocardiography 5 14. The finding of an abnormal diastolic response to stress is a sensitive,15 but not specific, marker of ischaemia, as it may be produced by non-ischaemic processes, including LV hypertrophy. An abnormal filling pattern response to exercise echocardiography is associated with increased risk of cardiovascular death and hospitalisation on follow-up.…”

Section: Discussionmentioning

confidence: 99%

Effects of myocardial ischaemia on left ventricular untwist and filling pressure

Lam

Leano

Haluska

et al. 2011

Heart

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Left Ventricular Diastolic Filling Pressures During Dobutamine Stress Echocardiography: Relationship to Symptoms and Ischemia

Cited by 21 publications

References 30 publications

Stress-induced worsening of left ventricular diastolic function as a marker of myocardial ischemia

Stress-induced worsening of left ventricular diastolic function as a marker of myocardial ischemia

Prognostic Implications of Left Ventricular Filling Pressure With Exercise

Effects of myocardial ischaemia on left ventricular untwist and filling pressure

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