Variable Hemodynamic Responses during Diastolic Stress Echocardiography in Patients Who Have Relaxation Abnormality with Possible Elevated Filling Pressure
- Author:
Jeong Yoon JANG
1
;
Sahmin LEE
;
Dae Hee KIM
;
Jong Min SONG
;
Duk Hyun KANG
;
Jae Kwan SONG
Author Information
- Publication Type:Original Article
- Keywords: Diastole; Exercise; Doppler echocardiography
- MeSH: Arterial Pressure; Blood Pressure; Diastole; Echocardiography; Echocardiography, Doppler; Echocardiography, Stress; Hemodynamics; Humans; Hypertension, Pulmonary; Incidence; Male; Multivariate Analysis; Prospective Studies; Pulmonary Artery; Relaxation
- From:Korean Circulation Journal 2018;48(8):744-754
- CountryRepublic of Korea
- Language:English
- 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.
