Prognostic implications of left ventricular filling pressure with exercise.
BACKGROUND
The estimation of left ventricular (LV) filling pressure from the ratio of transmitral and annular velocities (E/e') after exercise echocardiography may identify diastolic dysfunction in patients who complain of exertional dyspnea. This study sought to determine the relative contributions of exercise E/e' and ischemia to outcomes in patients referred for exercise echocardiography.


RESULTS
Rest and exercise E/e' were obtained in 522 patients referred for exercise echocardiography, who were followed for cardiovascular death and hospitalization over a median of 13.2 months. Exercise E/e' >2 SD from normal was used to denote raised LV filling pressure with stress (n=75), and ischemia (n=250) was identified by inducible wall motion abnormalities. There were 65 cardiovascular hospitalizations during the follow-up period. Survival analysis showed patients without ischemia and with normal exercise E/e' to have a better prognosis than those with ischemia, with or without raised exercise E/e' (P=0.003) and the outcomes of patients with isolated raised exercise E/e' and isolated ischemia to be similar. Exercise E/e' was most valuable in patients with normal resting E/e'; those with elevation with exercise had a worse outcome than those with normal exercise E/e' (P=0.014). Exercise capacity (hazard ratio, 0.893; P=0.008), exercise wall motion score index (hazard ratio, 1.507; P<0.001), and exercise E/e' >14.5 (hazard ratio, 2.988; P=0.002) were independent predictors of outcome. The addition of exercise E/e' to exercise capacity and wall motion score index resulted in an increment in model power to predict adverse outcome (P=0.006).


CONCLUSIONS
Exercise E/e' is associated with cardiovascular hospitalization, independent of and incremental to inducible ischemia.
School of Medicine, The University of Queensland, Brisbane, Australia.
David J
DJ
Holland
Sandhir B
SB
Prasad
Thomas H
TH
Marwick
D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003971:Diastole; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D025401:Echocardiography, Stress; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D016019:Survival Analysis; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D017725:Ventricular Pressure