Diastolic stress echocardiography in Japanese elderly patients: prevalence and features of patients with elevated left ventricular filling pressure after treadmill stress.
OBJECTIVE
This study attempted to evaluate the prevalence and features of elderly patients with elevated post-exercise left ventricular (LV) filling pressure in Japan.


BACKGROUND
Previous studies have validated that LV filling pressure during exercise can be estimated non-invasively by the Doppler index of diastolic filling (E/E'), and diastolic stress echocardiography has been promoted. There is limited information about diastolic stress echocardiography in Japan.


METHODS
Three hundred ten elderly patients aged ≥60 years who underwent treadmill stress echocardiography were studied. Patients with ischemic response were excluded. Doppler measurements were made before and immediately after the treadmill stress, and patients were divided into two groups regarding post-exercise E/E' with cutoff values of 15. Clinical and echocardiographic characteristics were compared between the two groups.


RESULTS
One-third (33.9%) of the patients presented elevated post-exercise LV filling pressure indicated by E/E' ≥15. Patients with an elevated post-exercise E/E' were older (p = 0.0052), had a greater mean body mass index (p = 0.0459), were more likely to have an abnormal glucose tolerance (p = 0.0059), had a greater LV mass index (p = 0.0383), a greater left atrial volume index (p = 0.0042), and a higher E/E' value at rest (p < 0.0001).


CONCLUSIONS
One-third of the Japanese elderly patients who were referred for treadmill stress echocardiography and not limited by ischemia presented elevated post-exercise LV filling pressure indicated by E/E' ≥15. These patients are likely to have clinical and echocardiographic characteristics of heart failure with preserved ejection fraction.
Takagi Cardiology Clinic, Mibu Kayogosho-cho 3-3, Nakagyo-ku, Kyoto, 604-8811, Japan. tcardiol@qb4.so-net.ne.jp.
Tsutomu
T
Takagi
Osaka Ekisaikai Hospital, Osaka, Japan.
Junichi
J
Yoshikawa
Diastolic dysfunction; Diastolic stress echocardiography; Doppler echocardiography; Exercise stress echocardiography; Tissue Doppler echocardiography