Prognostic Implications of Left Ventricular Filling Pressure With Exercise

Holland, David J.; Prasad, S.; Marwick, Thomas H.

doi:10.1161/circimaging.109.908152

Cited by 103 publications

(68 citation statements)

References 39 publications

(46 reference statements)

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“…Importantly, the elevated E/e′ ratio with exercise has been associated with adverse cardiovascular outcomes even when detectable ischemia is considered [37]. Diastolic stress testing with intravenous dobutamine infusion, although infrequent in current clinical practice, has also been shown to predict clinical events in cardiac patients [38].…”

Section: Diastolic Stress Testmentioning

confidence: 99%

Echocardiographic Evaluation of Left Ventricular Diastolic Function: an Update

Maragiannis

Nagueh

2015

Curr Cardiol Rep

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Echocardiographic evaluation of diastolic properties and assessment of hemodynamic status of the right and the left ventricle have been traditionally applied for many years in clinical practice. Establishment of diagnosis of diastolic dysfunction, grading, and estimation of filling pressures noninvasively adds prognostic information to the clinician, which may affect treatment management. Novel methods, including left atrium strain, left ventricular diastolic strain rate, and left ventricular untwisting rate, have been imported in clinical practice attempting to provide a more comprehensive and more accurate understanding of the mechanisms and diagnosis of diastolic dysfunction.

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Section: Diastolic Stress Testmentioning

confidence: 99%

Echocardiographic Evaluation of Left Ventricular Diastolic Function: an Update

Maragiannis

Nagueh

2015

Curr Cardiol Rep

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“…22 Furthermore, a recent study showed the incremental prognostic value of exercise E/eЈ ratio over clinical variables and exercise wall motion score index. 23 Collectively, there is growing evidence that the diastolic stress test can provide important diagnostic findings that can be helpful in the management of patients presenting with dyspnea of an unclear etiology. Because dobutamine is a vasodilator as well as an inotrope, the hemodynamic response to dobutamine is very different from that of exercise.…”

Section: Diastolic Stress Testmentioning

confidence: 99%

Established and Novel Clinical Applications of Diastolic Function Assessment by Echocardiography

Park

Nagueh

2011

Circ: Cardiovascular Imaging

141

120

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A cardiac cycle consists of systolic (contraction) and diastolic (relaxation and filling) phases that are linked closely together for optimal function of the heart. Normal diastolic function allows adequate filling of the heart without an excessive increase in diastolic filling pressure both in the resting state and with stress or exertion. 1 The diastolic phase is remarkably well designed to ensure that the ventricle is optimally filled for a given clinical condition. 2 Basically, at the end of systole, left ventricular (LV) relaxation begins as an initial diastolic process, and LV pressure falls rapidly as the LV expands. This relaxation phase is accompanied by active movement of the mitral annulus away from the apex. The velocity of LV dilatation and mitral annular movement during early diastole correlates well with how fast the LV fills and relaxes, respectively. 3,4 Myocardial relaxation continues during early diastole to reach the minimal LV diastolic pressure, which helps with "sucking" or "pulling" the blood actively into the LV (Figure 1, online-only Data Supplement Video 1A). The minimal LV diastolic pressure or completion of relaxation normally occurs by 3.5 times the value of tau-the time constant of relaxation (normal Ͻ45 ms)-after the mitral opening. 5 LV pressure then rises to be equilibrated with left atrial (LA) pressure, at which time the early diastolic filling decelerates to close the mitral valve until the time of atrial contraction when LA pressure increases to initiate the late filling to complete diastole ( Figure 1, online-only Data Supplement Video 1B).In the healthy young heart, early diastole is responsible for the majority of ventricular filling, providing a good diastolic reserve. As myocardial relaxation becomes less active with aging or abnormally delayed due to a disease process, the rate of LV pressure decline during the early diastole is reduced, and it takes a longer time to reach the minimal LV diastolic pressure. The rate of LV dilatation during early diastole is reduced, and both elongation of the LV and mitral annular motion are reduced (Figure 1), resulting in reduced diastolic filling and a longer time to reach equilibration of LV-LA pressure. Under this circumstance, atrial contraction is responsible for a substantial proportion of diastolic filling. As long as all the necessary filling can be completed through this mechanism with intact atrial contraction and an adequate diastolic filling period, the mean LA pressure remains normal, although it may be increased at the end of diastole if LA compliance is decreased.A major problem with delayed relaxation, however, is a reduced diastolic reserve. Healthy individuals with normal relaxation are able to increase the rate of myocardial relaxation when there is a need for increased diastolic filling. Faster relaxation allows the achievement of a lower minimal LV diastolic pressure at a shorter time interval than in the resting state. Hence, increased LV filling can occur even with a shortened diastolic filling time. When myoca...

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“…An increase in the E/e´ ratio under physical exercise indicates a concomitant increase in LV end-diastolic pressures and a worse prognosis. 15,16 Strain rate during the isovolumetric relaxation time (IVRsr) or early diastolic strain rate (e´sr), derived from global longitudinal speckletracking strain, were recently proposed to estimate LV filling pressures, although both parameters are still experimental. 17 …”

Section: Diastolic Functionmentioning

confidence: 99%

Novel Imaging Techniques for Heart Failure

Melero-Ferrer

López‐Vilella

Morillas-Climent

et al. 2016

Cardiac Failure Review

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Heart failure (HF) is an epidemic with an increasing prevalence and an absolute mortality rate of approximately 50 % within 5 years of diagnosis. Imaging plays a main role in HF diagnosis, assessment of aetiology and treatment guidance. This article reviews current HF applications for all the available non-invasive imaging modalities: echocardiography, cardiovascular magnetic resonance (CMR), nuclear imaging-positron emission tomography (PET) and single-photon emission computed tomography (SPECT) and computed tomography (CT). Echocardiography, with its recent developments, such as 3D echo, is the main imaging test used in the evaluation of HF patients, given its availability and reliability in assessing cardiac structure and function. CMR allows the characterisation of myocardial tissue, in addition to providing information on the structure and cardiac function, so it is a great help in the determination of HF aetiology and may predict patient outcomes. Nuclear imaging can detect ischaemia and viability and can obtain additional prognostic data. Cardiac CT is EchocardiographyAlthough echocardiography is a relatively 'ancient' technique, its versatility makes it unique in the provision of volumes, function, haemodynamics or valvular regurgitation. In addition, because of its availability, safety and low cost, echocardiography is the first and most widely used test for the diagnosis, selection of appropriate treatment and prognosis of HF.1 Echocardiography is also the most used imaging method in the reassessment of HF patients. It remains unclear when to repeat echocardiographic exams, but it is deemed appropriate at least in patients with worsening symptoms. Systolic FunctionGlobal left ventricular (LV) function is of paramount importance regarding therapeutic decisions. Visual estimation of ejection fraction (EF), the Teichholz and Simpson methods, have been widely validated. 2,3However, in 2D imaging, because of its operator-dependent nature, repeated testing has a high probability of producing variable volume and EF results.The apparition of 3D fully sampled matrix transthoracic echocardiography has enabled easier acquisition of images, 4 simplifying its routinary application. There have been many studies comparing 2D and 3D echocardiography (2DE and 3DE) and a 'reference' standard (generally CMR). A recent meta-analysis of all 3DE studies evaluating LV volumes and EF demonstrated that 3DE generally underestimated volumes, but not as significantly as 2DE. There was also less variability than 2D compared with CMR.5 Nonetheless, 3DE echocardiography may be challenging and not practical in patients with low image quality (e.g. critical patients), in whom 2DE measures are more realiable. 3DE is also a less standardised techique than 2DE, and because of this reason most laboratories use the more universally applicable 2DE measurements in clinical practice. Only recently, large analyses of LV parameters using 3DE in large cohorts of healthy individuals have been published to establish race, age and gender-specific ...

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Prognostic Implications of Left Ventricular Filling Pressure With Exercise

Cited by 103 publications

References 39 publications

Echocardiographic Evaluation of Left Ventricular Diastolic Function: an Update

Echocardiographic Evaluation of Left Ventricular Diastolic Function: an Update

Established and Novel Clinical Applications of Diastolic Function Assessment by Echocardiography

Novel Imaging Techniques for Heart Failure

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