title: Usefulness of the evaluation of left ventricular diastolic function changes during stress echocardiography in predicting exercise capacity in patients with ischemic heart failure.
abstract: BACKGROUND
  Diastolic dysfunction and elevated left ventricular (LV) filling pressure at rest are key factors of exercise intolerance in patients with heart failure (HF). There are few studies, however, that have addressed the issue of changes of LV diastolic function and filling pressure during exercise in patients with HF with severe systolic dysfunction. The ratio of early diastolic velocity of mitral inflow (E) and early myocardial diastolic velocity (E') strongly correlates with invasively obtained LV filling pressure.
  
  
  OBJECTIVE
  We sought to assess dynamic changes of diastolic function, including LV filling pressure using Doppler tissue imaging, during stress echocardiography and its impact on exercise capacity in patients with ischemic HF.
  
  
  METHODS
  We studied 50 adult patients (44 male and 6 female) with a mean age of 62.9 +/- 8.8 (46-79) years, mean New York Heart Association class of 1.97 +/- 0.86, and mean ejection fraction of 28.4 +/- 9.5 (10%-45%). The following conventional and tissue Doppler parameters were measured at baseline and peak exercise during semisupine stress echocardiography (20 W, 2-minute increments): peak early (E) and late (A) diastolic velocity of the mitral inflow, E/A ratio, peak early myocardial diastolic velocity (E'), and E/E' ratio. Diastolic Doppler tissue imaging indices were derived from septal, lateral, anterior, and inferior border of the mitral annulus in the apical 4- and 2-chamber views. Simultaneously during stress echocardiography peak oxygen uptake was measured. Patients were divided into two groups according to peak oxygen uptake value: group 1 with 23 patients (< 14 mL/kg/min) and group 2 with 27 patients (> or = 14 mL/kg/min).
  
  
  RESULTS
  There were significant differences in terms of E' and E/E' ratios both at rest and peak exercise between the two groups. The best correlation with exercise capacity was E/E' at peak stress (r = -0.75, P < .0001). The most useful parameter for identifying severe exercise intolerance, as indicated by peak oxygen uptake less than 14 mL/kg/min, was E/E' at peak stress with an area under receiver operating characteristic curve of 0.92. The cut-off of 18.2 for E/E' at peak stress showed a sensitivity of 85.2% with a specificity of 95.6%.
  
  
  CONCLUSIONS
  The evaluation of hemodynamic response of diastolic function, including LV filling pressure, during exercise is feasible during stress echocardiography and provides valuable information in predicting exercise capacity in patients with ischemic HF.
authors.affiliation: Department of Cardiac and Vascular Disease, John Paul II Hospital, Krakow, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Podolec
authors.forename: Paweł
authors.initials: P
authors.lastname: Rubís
authors.forename: Lidia
authors.initials: L
authors.lastname: Tomkiewicz-Pajak
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Kopeć
authors.forename: Wiesława
authors.initials: W
authors.lastname: Tracz
mesh_terms: D000368:Aged; D003971:Diastole; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test / Q000379:methods; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*