Diastolic Stress Test: Invasive and Noninvasive Testing
Jong-Won Ha1, Oyvind S Andersen2, Otto A Smiseth2
1Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Insights
Diastolic dysfunction, a common cause of heart failure with preserved ejection fraction, often presents only during exercise. Diastolic stress testing is crucial for diagnosing this condition when resting measurements are normal.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Diastolic dysfunction is a primary driver in heart failure pathogenesis, affecting approximately 50% of cases.
- It is characterized by elevated left ventricular filling pressures, often with normal systolic function.
- Diastolic dysfunction is frequently an incidental finding, with symptoms manifesting during physical exertion.
Purpose of the Study:
- To highlight the clinical necessity of diastolic stress testing.
- To review the role of both invasive and noninvasive diastolic stress testing methods.
- To underscore the importance of evaluating diastolic function under exercise conditions.
Main Methods:
- The review focuses on the evaluation of diastolic function during exercise.
- Methods discussed include both invasive and noninvasive diagnostic approaches.
- Emphasis is placed on assessing left ventricular filling pressures during exertion.
Main Results:
- Many patients exhibit impaired diastolic function on Doppler echocardiography without resting symptoms.
- Symptoms commonly emerge during exercise due to exercise-induced increases in left ventricular filling pressure.
- Resting measurements may not accurately reflect the functional status of diastolic function.
Conclusions:
- Diastolic stress testing is essential for diagnosing heart failure related to diastolic dysfunction.
- Evaluating diastolic function during exercise provides critical clinical insights.
- Both invasive and noninvasive stress tests are valuable tools for comprehensive assessment.
Abstract:
Diastolic dysfunction is a key factor in the pathogenesis of heart failure. Around 50% of cases of heart failure, the hemodynamic correlate of which is increased left ventricular filling pressure, are caused by diastolic dysfunction in the setting of apparently normal systolic function. Due to its high prevalence, diastolic dysfunction is often recognized as an incidental finding. Many patients have Doppler echocardiographic evidence of impaired diastolic function but do not have any symptoms of heart failure at rest. In many of these patients, symptoms of diastolic dysfunction occur only during exercise, as left ventricular filling pressure is normal at rest, but increases with exercise. This implies that filling pressures should also be measured during exercise. The diastolic stress test refers to the evaluation of diastolic function, either invasively or noninvasively, during exercise. This review focuses on the clinical need for diastolic stress testing, both invasively and noninvasively.
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