title: Exercise-induced changes in left ventricular filling pressure after myocardial infarction assessed with simultaneous right heart catheterization and Doppler echocardiography.
abstract: BACKGROUND
  To assess whether changes in E/e´ (the ratio between peak early mitral inflow velocity (E) and peak early mitral annulus velocity (e´)) during exercise reflect changes in filling pressure in patients with a recent myocardial infarction (MI) and mild to moderate diastolic dysfunction at rest. A low E/e´ ratio is associated with low filling pressures while a high E/e´ ratio is associated with high filling pressures. In the intermediate range of E/e´ guidelines suggest additional measurements during exercise in order to determine filling pressures.
  
  
  RESULTS
  Sixty-one patients with a recent MI and left ventricular ejection fraction (LVEF) ≥ 45%, left atrium (LA)>34 ml/m(2) and E/e´ between 8 and 15, underwent simultaneous right heart catheterization and Doppler echocardiography during a symptom limited semi supine cycle exercise test. E velocity increased from 75 ± 16 to 139 ± 27 cm/s and e´ increased from 7.1 ± 1.4 to 16.1 ± 3.6 cm/s with exercise. Thus, E/e´ decreased from 10.5 ± 1.7 to 9.3 ± 2.3 while pulmonary capillary wedge pressure (PCWP) increased from 13 ± 4 to 33 ± 8 mmHg. There was no correlation between LV filling pressure and E/e´ at rest, at 4 METS, at peak exercise or 5 min after termination of exercise. Neither was there any correlation between changes in PCWP and changes in E/e´.
  
  
  CONCLUSIONS
  For post-MI patients with resting E/e´ in the intermediate range changes in E/e´ with physical exercise does not reflect changes in LV filling pressures.
authors.affiliation: Department of Cardiology, the Heart Centre, Rigshospitalet&Copenhagen University, Denmark. Electronic address: madsand@dadlnet.dk.
authors.forename: Mads J
authors.initials: MJ
authors.lastname: Andersen
authors.forename: Mads
authors.initials: M
authors.lastname: Ersbøll
authors.forename: Finn
authors.initials: F
authors.lastname: Gustafsson
authors.forename: Anna
authors.initials: A
authors.lastname: Axelsson
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.forename: Søren
authors.initials: S
authors.lastname: Boesgaard
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: Jacob E
authors.initials: JE
authors.lastname: Møller
mesh_terms: D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D016277:Ventricular Function, Left
keywords: Exercise; Heart catheterization; Myocardial infarction; Stress echocardiography; Ventricular diastolic dysfunction