Korean Circ J.  2018 Aug;48(8):744-754. 10.4070/kcj.2018.0046.

Variable Hemodynamic Responses during Diastolic Stress Echocardiography in Patients Who Have Relaxation Abnormality with Possible Elevated Filling Pressure

• Jang JY
• Lee S
• Kim DH
• Song JM
• Kang DH
• Song JK

• KMID: 2417699
• DOI: http://doi.org/10.4070/kcj.2018.0046

Abstract

BACKGROUND AND OBJECTIVES
The clinical characteristics of patients with diastolic dysfunction characterized by a relaxation abnormality with possible elevated filling pressure is remain to be determined. We sought to test whether diastolic stress echocardiography (DSE) is useful for characterization of these patients.
METHODS
A total of 120 patients (58 men, mean age of 64±7 years) with E/A ratio < 1.0 (mean±SD, 0.7±0.1) and 10≤ E/e' < 15 at rest echocardiography was enrolled prospectively for supine bicycle exercise up to 50 W.
RESULTS
During exercise, 47 patients (39%) showed high left ventricular filling pressure (E/e' > 15, hLVFP) and 40 (30%) developed exercise-induced pulmonary hypertension (systolic pulomary arterial pressure > 50 mmHg, EiPH) without hLVFP. The remaining 33 patients did not show hLVFP or EiPH. The incidence of EiPH with hLVFP was 21% (25/120). By multivariate analysis, age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.00-1.13; p=0.039) and systolic pulmonary artery pressure at rest (OR, 1.14; 95% CI, 1.02-1.27; p=0.02) were associated with EiPH, whereas late diastolic transmitral velocity (OR, 1.04; 95% CI, 1.00-1.08; p=0.03) and diastolic blood pressure (OR, 0.94; 95% CI, 0.90-0.99; p=0.02) were associated with hLVFP during exercise.
CONCLUSIONS
Patients with relaxation abnormality and possibly hLVFP showed markedly heterogeneous hemodynamic changes during low-level exercise and DSE was useful to characterize these patients.

Keyword

Diastole; Exercise; Doppler echocardiography

MeSH Terms

Arterial Pressure
Blood Pressure
Diastole
Echocardiography
Echocardiography, Doppler
Echocardiography, Stress*
Hemodynamics*
Humans
Hypertension, Pulmonary
Incidence
Male
Multivariate Analysis
Prospective Studies
Pulmonary Artery
Relaxation*

Figure

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  Figure 1 Representative Doppler tracings of patients with impaired relaxation and possibly hLVFP who showed (A) no significant change, (B) hLVFP without pulmonary hypertension, (C) pulmonary hypertension without hLVFP and (D) pulmonary hypertension with hLVFP during diastolic stress echocardiography. hLVFP = high left ventricular filling pressure; TR = tricuspid regurgitation; W = watts.

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