Assessment of diastolic function during exercise echocardiography: annulus mitral velocity or transmitral flow...

Area of Science:

• Cardiology
• Echocardiography
• Diastolic Function Assessment

Background:

• The E/e' index is a known indicator of left ventricular (LV) filling pressures.
• Comparison between LV diastolic pattern (DP) and E/e' index during exercise echocardiography (EE) is lacking.

Purpose of the Study:

• To evaluate the reproducibility and correlation of LV diastolic pattern (DP) during exercise echocardiography (EE).
• To compare the efficacy of LV DP assessment versus the E/e' index in predicting exercise echocardiography outcomes.

Main Methods:

• 179 patients undergoing EE had conventional pulsed Doppler and Doppler myocardial imaging performed at rest and post-exercise.
• Measurements included early (E) and late (A) LV inflow velocities and septal annulus e' velocity.
• Left ventricular diastolic patterns (DP) were categorized, and E/e' values were analyzed against exercise parameters.

Main Results:

• Four distinct LV diastolic patterns (DP) were identified: abnormal relaxation (AR) and restrictive pattern (RP).
• The E/e' index showed moderate accuracy in predicting abnormal EE, poor functional capacity, and lack of LVEF increase.
• RP at rest or post-exercise demonstrated higher specificity but lower sensitivity compared to E/e' cutoffs for predicting adverse outcomes.

Conclusions:

• The E/e' index alone is insufficient for further stratification in patients with exercise-induced restrictive patterns (RP).
• Combining E/e' measurement with LV diastolic pattern (DP) assessment during EE is recommended for comprehensive diastolic function evaluation.
• Persistent or exercise-induced RP may not require further assessment beyond DP and E/e' evaluation.