Abstract 14094: Diastolic Function Behavior in Patients With a Positive Exercise Stress Echocardiogram
Background: Little information exists about the relationship of exertional changes in diastolic function to the extent and severity of exercise-induced ischemia. We characterized echocardiographic parameters of diastolic function in patients with a positive stress echocardiogram.
Methods: In 699 consecutive patients with a positive treadmill exercise stressechocardiogram, diastolic function was assessed at rest and at peak exercise; regional wall motion score index (RWSI) were assessed on the basis of wall motion and systolic thickening, diastolic profile was assessed by mitral inflow velocities (E and A waves), tissue velocities of the mitral annulus (e'), deceleration time (DT), E/A ratio and E/e' were calculated at rest and peak stress and LA volume index (LAVI) at rest. Right ventricular systolic pressure values (RVSP) at rest and post exercise were included. Patients at rest were divided in three groups E/e' < 8 (group 1), ≥ 8 and ≤ 15 (Group 2) and > 15 (Group 3), and into quartiles according to the change RWSI (Peak - rest) with the 4th quartile including most ischemia.
Results: The average age was 66 [10.47] and 60% were men. Hypertension was present in 76 %, Diabetes in 17%, hyperlipidemia in 76% and 51% smokers. E/e' at peak stress did not differ across RWSI quartiles (Q1:11.8, Q2: 11.0, Q3: 11.1 and Q4:11.7; p =NS). Higher resting LA volume index (LAVI) was present in those with the worst RWSI at peak stress (p < 0.02). Patients with an E/e' at rest >15 had higher levels of E/e' post exertion (P=<0.0001). There was an inverse correlation between EF and E/e' after exertion; patients with E/e' <8, EF: 62.6%; patients with E/e'>15, EF: 58.1% (P < 0.01); Dyspnea and Right ventricular systolic pressure (RVSP) were similar in all the RWMA quartiles. After Exercise patients with E/e' <8 achieved 9.56 METS, E/e' >8 - <15 achieved 8.67 METS and patients with E/e' >15 achieved 7.42 METS (P=<0.0001).
Conclusions: Diastolic dysfunction measured by E/e' is not correlated with the change in RWSI with exercise. There was a direct association between resting LAVI and post exercise RWSI, and an inverse correlation between peak stress E/e' with workload and EF.
- © 2011 by American Heart Association, Inc.