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Assessment of diastolic function during exercise echocardiography: annulus mitral velocity or transmitral flow pattern?
J Am Soc Echocardiogr. 2008 Feb; 21(2):178-84.JA

Abstract

OBJECTIVES

We hypothesize that the change in the left ventricular (LV) diastolic pattern (DP) may be measured with high reproducibility and correlates with exercise echocardiography (EE) better than the ratio of early LV inflow velocity to early diastolic annulus velocity (E/e' index).

BACKGROUND

The E/e' index has been related to LV filling pressures but has not been compared with DP.

METHODS

We selected 179 consecutive patients who were referred for EE. Early (E) and late (A) LV inflow velocities by conventional pulsed Doppler, and septal annulus e' velocity by pulsed Doppler myocardial imaging were measured at rest (R) and post-exercise (PE).

RESULTS

Four LV-DPs were found: abnormal relaxation (AR) at R and PE (E < A) in 110 patients; AR at PE (E > A at R; E < A at PE) in 22 patients; restrictive pattern (RP) at R and PE (E > A) in 18 patients; and RP at PE (E < A at R; E > A at PE) in 29 patients. The more accurate PE cutoff E/e' values to predict abnormal EE, ischemic response, poor functional capacity (< 8 Mets in men; < 6 Mets in women), and lack of increase in left ventricular ejection fraction (LVEF) were 12, 12, 11, and 11 (areas under the curve were 0.53, 0.53, 0.63, and 0.57, respectively). Corresponding areas under the curve for an RP at R + PE or only at PE were 0.57, 0.55, 0.54, and 0.56 (P = not significant). The sensitivity of an RP at R + PE or only at PE was lower and the specificity was higher than those of the different E/e' cutoff values for predicting abnormal EE, functional capacity, ischemic response, and lack of increase in LVEF. Achieved Mets were lower in patients with an RP at R + PE or only at PE irrespectively of the E/e' values, whereas achieved Mets in patients with AR at R + PE or only at PE were lower if the E/e' was > or = 11 (8.2 +/- 2.9 vs. 9.8 +/- 3.1, P = .01). Interobserver and intraobserver concordance were 95% (kappa = 0.86) and 100% (kappa = 1.0) for an RP, and 86% (kappa = 0.73) and 92% (kappa = 0.78) for a PE-E/e' value of > or = 11.

CONCLUSIONS

E/e' does not allow further stratification in patients with exercise RP. We propose both measurement of E/e' and determination of the LV-DP (a quickly assessable variable) for the assessment of diastolic function during EE. However, when an RP persists or develops with exercise, further assessment may not be more informative.

Authors+Show Affiliations

Unit of Echocardiography and Department of Cardiology, Juan Canalejo Hospital, University of A Coruña, A Coruña, Spain. pete@canalejo.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

17658729

Citation

Peteiro, Jesús, et al. "Assessment of Diastolic Function During Exercise Echocardiography: Annulus Mitral Velocity or Transmitral Flow Pattern?" Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography, vol. 21, no. 2, 2008, pp. 178-84.
Peteiro J, Pazos P, Bouzas A, et al. Assessment of diastolic function during exercise echocardiography: annulus mitral velocity or transmitral flow pattern? J Am Soc Echocardiogr. 2008;21(2):178-84.
Peteiro, J., Pazos, P., Bouzas, A., Piñon, P., Estevez, R., & Castro-Beiras, A. (2008). Assessment of diastolic function during exercise echocardiography: annulus mitral velocity or transmitral flow pattern? Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography, 21(2), 178-84.
Peteiro J, et al. Assessment of Diastolic Function During Exercise Echocardiography: Annulus Mitral Velocity or Transmitral Flow Pattern. J Am Soc Echocardiogr. 2008;21(2):178-84. PubMed PMID: 17658729.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Assessment of diastolic function during exercise echocardiography: annulus mitral velocity or transmitral flow pattern? AU - Peteiro,Jesús, AU - Pazos,Pablo, AU - Bouzas,Alberto, AU - Piñon,Pablo, AU - Estevez,Roi, AU - Castro-Beiras,Alfonso, Y1 - 2007/07/20/ PY - 2007/04/17/received PY - 2007/7/31/pubmed PY - 2008/3/28/medline PY - 2007/7/31/entrez SP - 178 EP - 84 JF - Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography JO - J Am Soc Echocardiogr VL - 21 IS - 2 N2 - OBJECTIVES: We hypothesize that the change in the left ventricular (LV) diastolic pattern (DP) may be measured with high reproducibility and correlates with exercise echocardiography (EE) better than the ratio of early LV inflow velocity to early diastolic annulus velocity (E/e' index). BACKGROUND: The E/e' index has been related to LV filling pressures but has not been compared with DP. METHODS: We selected 179 consecutive patients who were referred for EE. Early (E) and late (A) LV inflow velocities by conventional pulsed Doppler, and septal annulus e' velocity by pulsed Doppler myocardial imaging were measured at rest (R) and post-exercise (PE). RESULTS: Four LV-DPs were found: abnormal relaxation (AR) at R and PE (E < A) in 110 patients; AR at PE (E > A at R; E < A at PE) in 22 patients; restrictive pattern (RP) at R and PE (E > A) in 18 patients; and RP at PE (E < A at R; E > A at PE) in 29 patients. The more accurate PE cutoff E/e' values to predict abnormal EE, ischemic response, poor functional capacity (< 8 Mets in men; < 6 Mets in women), and lack of increase in left ventricular ejection fraction (LVEF) were 12, 12, 11, and 11 (areas under the curve were 0.53, 0.53, 0.63, and 0.57, respectively). Corresponding areas under the curve for an RP at R + PE or only at PE were 0.57, 0.55, 0.54, and 0.56 (P = not significant). The sensitivity of an RP at R + PE or only at PE was lower and the specificity was higher than those of the different E/e' cutoff values for predicting abnormal EE, functional capacity, ischemic response, and lack of increase in LVEF. Achieved Mets were lower in patients with an RP at R + PE or only at PE irrespectively of the E/e' values, whereas achieved Mets in patients with AR at R + PE or only at PE were lower if the E/e' was > or = 11 (8.2 +/- 2.9 vs. 9.8 +/- 3.1, P = .01). Interobserver and intraobserver concordance were 95% (kappa = 0.86) and 100% (kappa = 1.0) for an RP, and 86% (kappa = 0.73) and 92% (kappa = 0.78) for a PE-E/e' value of > or = 11. CONCLUSIONS: E/e' does not allow further stratification in patients with exercise RP. We propose both measurement of E/e' and determination of the LV-DP (a quickly assessable variable) for the assessment of diastolic function during EE. However, when an RP persists or develops with exercise, further assessment may not be more informative. SN - 1097-6795 UR - https://www.unboundmedicine.com/medline/citation/17658729/Assessment_of_diastolic_function_during_exercise_echocardiography:_annulus_mitral_velocity_or_transmitral_flow_pattern L2 - https://linkinghub.elsevier.com/retrieve/pii/S0894-7317(07)00473-7 DB - PRIME DP - Unbound Medicine ER -