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KMID : 0368120180480080744
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Korean Circulation Journal
2018 Volume.48 No. 8 p.744 ~ p.754
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Variable Hemodynamic Responses during Diastolic Stress Echocardiography in Patients Who Have Relaxation Abnormality with Possible Elevated Filling Pressure
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Jang Jeong-Yoon
Lee Sah-Min
Kim Dae-Hee
Song Jong-Min
Kang Duk-Hyun
Song Jae-Kwan
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Abstract
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Background and Objectives: The clinical characteristics of patients with diastolic dysfunction characterized by a relaxation abnormality with possible elevated filling pressure is remain to be determined. We sought to test whether diastolic stress echocardiography (DSE) is useful for characterization of these patients.
Methods: A total of 120 patients (58 men, mean age of 64±7 years) with E/A ratio <1.0 (mean±SD, 0.7±0.1) and 10≤ E/e' <15 at rest echocardiography was enrolled prospectively for supine bicycle exercise up to 50 W.
Results: During exercise, 47 patients (39%) showed high left ventricular filling pressure (E/e' >15, hLVFP) and 40 (30%) developed exercise-induced pulmonary hypertension (systolic pulomary arterial pressure >50 mmHg, EiPH) without hLVFP. The remaining 33 patients did not show hLVFP or EiPH. The incidence of EiPH with hLVFP was 21% (25/120). By multivariate analysis, age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.00?1.13; p=0.039) and systolic pulmonary artery pressure at rest (OR, 1.14; 95% CI, 1.02?1.27; p=0.02) were associated with EiPH, whereas late diastolic transmitral velocity (OR, 1.04; 95% CI, 1.00?1.08; p=0.03) and diastolic blood pressure (OR, 0.94; 95% CI, 0.90?0.99; p=0.02) were associated with hLVFP during exercise.
Conclusions: Patients with relaxation abnormality and possibly hLVFP showed markedly heterogeneous hemodynamic changes during low-level exercise and DSE was useful to characterize these patients.
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KEYWORD
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Diastole, Exercise, Doppler echocardiography
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