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Usefulness of the evaluation of left ventricular diastolic function changes during stress echocardiography in
Piotr Podolec1, Paweł Rubís, Lidia Tomkiewicz-Pajak
1Department of Cardiac and Vascular Disease, John Paul II Hospital, Krakow, Poland.
Insights
Assessing diastolic function during stress echocardiography helps predict exercise capacity in heart failure patients. The E/E
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Diastolic dysfunction and elevated left ventricular (LV) filling pressure are primary causes of exercise intolerance in heart failure (HF).
- Limited research exists on dynamic changes in LV diastolic function and filling pressure during exercise in patients with severe systolic dysfunction.
- The ratio of early diastolic mitral inflow velocity (E) to early myocardial diastolic velocity (E') correlates with invasive LV filling pressure measurements.
Purpose of the Study:
- To evaluate dynamic changes in diastolic function and LV filling pressure using Doppler tissue imaging during stress echocardiography.
- To determine the impact of these dynamic changes on exercise capacity in patients with ischemic heart failure.
Main Methods:
- Studied 50 patients with ischemic HF (mean ejection fraction 28.4%).
- Measured mitral inflow (E, A) and myocardial diastolic (E') velocities, E/A, and E/E' ratios at rest and peak exercise during semisupine stress echocardiography.
- Assessed peak oxygen uptake to define exercise capacity groups.
Main Results:
- Significant differences in E' and E/E' ratios were observed between groups at rest and peak exercise.
- The E/E' ratio at peak stress showed the strongest correlation with exercise capacity (r = -0.75, P < .0001).
- Peak stress E/E' ratio accurately identified severe exercise intolerance (AUC 0.92), with a cutoff of 18.2 offering 85.2% sensitivity and 95.6% specificity.
Conclusions:
- Stress echocardiography allows feasible evaluation of the hemodynamic response of diastolic function during exercise.
- This assessment provides valuable predictive information regarding exercise capacity in patients with ischemic heart failure.
Background:
Diastolic dysfunction and elevated left ventricular (LV) filling pressure at rest are key factors of exercise intolerance in patients with heart failure (HF). There are few studies, however, that have addressed the issue of changes of LV diastolic function and filling pressure during exercise in patients with HF with severe systolic dysfunction. The ratio of early diastolic velocity of mitral inflow (E) and early myocardial diastolic velocity (E') strongly correlates with invasively obtained LV filling pressure.
Objective:
We sought to assess dynamic changes of diastolic function, including LV filling pressure using Doppler tissue imaging, during stress echocardiography and its impact on exercise capacity in patients with ischemic HF.
Methods:
We studied 50 adult patients (44 male and 6 female) with a mean age of 62.9 +/- 8.8 (46-79) years, mean New York Heart Association class of 1.97 +/- 0.86, and mean ejection fraction of 28.4 +/- 9.5 (10%-45%). The following conventional and tissue Doppler parameters were measured at baseline and peak exercise during semisupine stress echocardiography (20 W, 2-minute increments): peak early (E) and late (A) diastolic velocity of the mitral inflow, E/A ratio, peak early myocardial diastolic velocity (E'), and E/E' ratio. Diastolic Doppler tissue imaging indices were derived from septal, lateral, anterior, and inferior border of the mitral annulus in the apical 4- and 2-chamber views. Simultaneously during stress echocardiography peak oxygen uptake was measured. Patients were divided into two groups according to peak oxygen uptake value: group 1 with 23 patients (< 14 mL/kg/min) and group 2 with 27 patients (> or = 14 mL/kg/min).
Results:
There were significant differences in terms of E' and E/E' ratios both at rest and peak exercise between the two groups. The best correlation with exercise capacity was E/E' at peak stress (r = -0.75, P < .0001). The most useful parameter for identifying severe exercise intolerance, as indicated by peak oxygen uptake less than 14 mL/kg/min, was E/E' at peak stress with an area under receiver operating characteristic curve of 0.92. The cut-off of 18.2 for E/E' at peak stress showed a sensitivity of 85.2% with a specificity of 95.6%.
Conclusions:
The evaluation of hemodynamic response of diastolic function, including LV filling pressure, during exercise is feasible during stress echocardiography and provides valuable information in predicting exercise capacity in patients with ischemic HF.
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