Abstract 2844: Preload Augmentation by Leg Elevation is Helpful in Triaging the Patients with Grade 1 Diastolic Dysfunction
Grade 1 diastolic dysfunction (DD) is a spectrum of a variety of conditions.
Objectives: We sought to investigate whether the responses of mitral inflow and annular velocity to leg elevation can provide additional information regarding triaging patients with grade 1 DD. One hundred fifty-four consecutive patients with hypertension with abnormal left ventricular (LV) relaxation on Doppler mitral inflow (early (E)/late (A) mitral inflow velocity <0.75 or deceleration time > 240 ms) were enrolled. Patients with LV ejection fractions less than 50%, a previous history of ischemic heart disease, inducible regional wall motion abnormality, valvular or myocardial disease, or any other volume overloading diseases were excluded. After resting evaluation, echo-Doppler measurements were performed during passive leg elevation and symptom-limited graded bicycle exercise. Patients were divided into two groups according to resting E/E’: Group I (E/E’<15) and II (E/E’≥15, n=23). Group I subjects were further subdivided into IA (persistent E/E’ <15, n=112) and IB (change to E/E’≥15, n=19) according to response to leg elevation. Group II had lower systolic (S’), early (E’), and late (A’) diastolic annular velocity, and diastolic reserve index to exercise (E’xΔE’50W) and higher LV elastance index (E/E’/stroke volume) than that of group IA; there was no significant difference compared to group IB. Group IB had more female predominance, older age, lower E’, higher diastolic elastance index, and higher E/E’ at 25W and 50W exercise accompanied by lower exercise capacity compared to group IA. Preload augmentation by leg elevation might provide additional information in triaging patients with grade 1 DD.