Advertisement

Click here for more guidelines.
2012 ACCF/ AATS/ SCAI/ STS Expert Consensus Document on Transcatheter Aortic Valve Replacement
ACCF/ SCAI/ STS/ AATS/ AHA/ ASNC/ HFSA/ SCCT 2012 Appropriate Use Criteria for Coronary Revascularization Focused Update
2012 ACCF/ AHA/ ACR/ SCAI/ SIR/ STS/ SVM/ SVN Key Data Elements and Definitions for Peripheral Atherosclerotic Vascular Disease

 
About JACC CME
Policy on Privacy and Confidentiality
Disclosures
Important Information
 

JACC Imaging Homepage JACC Interventions Homepage
Still not a subscriber to JACC Imaging or JACC Interventions?
Click here
to sign up now!

Submit Manuscripts
Author Information
Subscribe/Renew
Order Reprints
Email Alerts
Feedback
RSS Feed
CME
 
 

Cardiosmart
Cardiosource
CVN
Imaging Library
JACC Imaging
JACC Interventions
 
 

About the Journal
Editorial Board & Staff
 
CME Topic Collections Past Issues Search Current Issue Home
     

J Am Coll Cardiol, 2006; 47:1891-1900, doi:10.1016/j.jacc.2006.02.042 (Published online 30 March 2006).
© 2006 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
j.jacc.2006.02.042v1
47/9/1891    most recent
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Web of Science (68)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Burgess, M. I.
Right arrow Articles by Marwick, T. H.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Burgess, M. I.
Right arrow Articles by Marwick, T. H.

EXPEDITED REVIEW

Diastolic Stress Echocardiography: Hemodynamic Validation and Clinical Significance of Estimation of Ventricular Filling Pressure With Exercise

Malcolm I. Burgess, MD, MRCP*, Carly Jenkins, BSc, James E. Sharman, PhD and Thomas H. Marwick, MD, PhD, FACC

Department of Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Australia.

Manuscript received December 23, 2005; revised manuscript received February 27, 2006, accepted February 28, 2006.

* Reprint requests and correspondence: Dr. Malcolm Burgess, University of Queensland Department of Medicine, Level 4, Princess Alexandra Hospital, Ipswich Road, Brisbane QLD 4102, Australia. (Email: mburgess{at}soms.uq.edu.au).

OBJECTIVES: Our study attempted to validate a Doppler index of diastolic filling (E/E’) during exercise with simultaneously measured left ventricular diastolic pressure (LVDP), investigate its association with exercise capacity, and understand which patients to select for testing.

BACKGROUND: The ratio of early diastolic transmitral velocity to early diastolic tissue velocity approximates LVDP at rest, but there is limited validation of exercise E/E’ with invasive hemodynamic measurement, and its clinical implications are unclear.

METHODS: The ratio of early diastolic transmitral velocity to early diastolic tissue velocity was measured at rest and during supine cycle ergometry in 37 patients undergoing left heart catheterization. In addition to correlation between invasive and estimated LVDP, the accuracy of different cutoffs for identification of elevated LVDP (>15 mm Hg) was determined at both rest and exercise. Doppler index of diastolic filling was also measured at rest and immediately after maximal treadmill exercise in 166 patients to investigate the association between exercise E/E’ and exercise capacity (<8 metabolic equivalents [METs]).

RESULTS: In patients undergoing invasive measurement, nine (24%) had elevation of LVDP only during exercise. There was a good correlation between E/E’ and LVDP at rest (r = 0.67) and during exercise (r = 0.59), and the regressions at rest and exercise corresponded closely. Receiver-operator curve analysis indicated that a cutoff value of 13 for exercise E/E’ identified patients with an elevated LVDP during exercise. A post-exercise E/E’ >13 was highly specific (90%) for reduced exercise capacity, and even after classification of resting E/E’, exercise E/E’ permitted classification of patients with exercise capacity <8 METs or ≥8 METs.

CONCLUSIONS: The ratio of early diastolic transmitral velocity to early diastolic tissue velocity correlates with invasively measured LVDP during exercise. It can be used to reliably identify patients with elevated LVDP during exercise and reduced exercise capacity.

Abbreviations and Acronyms
  A velocity = late diastolic transmitral velocity
  E velocity = early diastolic transmitral velocity
  E’ = early diastolic tissue velocity
  E/E’ = ratio of early diastolic transmitral velocity to early diastolic tissue velocity
  LV = left ventricle/ventricular
  LVDP = left ventricular diastolic pressure
  MET = metabolic equivalent
  ROC = receiver-operator characteristic




This article has been cited by other articles:


Home page
 Eur J Heart FailHome page
F. W. G. Wenzelburger, Y. T. Tan, F. J. Choudhary, E. S. P. Lee, F. Leyva, and J. E. Sanderson
Mitral annular plane systolic excursion on exercise: a simple diagnostic tool for heart failure with preserved ejection fraction
Eur J Heart Fail, September 1, 2011; 13(9): 953 - 960.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
C. Y. Shim, S.-A. Kim, D. Choi, W.-I. Yang, J.-M. Kim, S.-H. Moon, H.-J. Lee, S. Park, E.-Y. Choi, N. Chung, et al.
Clinical outcomes of exercise-induced pulmonary hypertension in subjects with preserved left ventricular ejection fraction: implication of an increase in left ventricular filling pressure during exercise
Heart, September 1, 2011; 97(17): 1417 - 1424.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J Cardiovasc ImagingHome page
J. Meluzin, J. Sitar, J. Kristek, R. Prosecky, M. Pesl, H. Podrouzkova, V. Soska, R. Panovsky, and L. Dusek
The role of exercise echocardiography in the diagnostics of heart failure with normal left ventricular ejection fraction
Eur Heart J Cardiovasc Imaging, August 1, 2011; 12(8): 591 - 602.
[Abstract] [Full Text] [PDF]

Home page
 Circ Cardiovasc ImagingHome page
J. K. Oh, S.-J. Park, and S. F. Nagueh
Established and Novel Clinical Applications of Diastolic Function Assessment by Echocardiography
Circ Cardiovasc Imaging, July 1, 2011; 4(4): 444 - 455.
[Full Text] [PDF]

Home page
 HeartHome page
W. Lam, R. Leano, B. Haluska, and T. H. Marwick
Effects of myocardial ischaemia on left ventricular untwist and filling pressure
Heart, May 1, 2011; 97(9): 757 - 761.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
B. A. Borlaug and W. J. Paulus
Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment
Eur. Heart J., March 2, 2011; 32(6): 670 - 679.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J Cardiovasc ImagingHome page
M. Izumo, K. Suzuki, M. Moonen, S. Kou, T. Shimozato, A. Hayashi, Y. J. Akashi, N. Osada, K. Omiya, F. Miyake, et al.
Changes in mitral regurgitation and left ventricular geometry during exercise affect exercise capacity in patients with systolic heart failure
Eur Heart J Cardiovasc Imaging, January 1, 2011; 12(1): 54 - 60.
[Abstract] [Full Text] [PDF]

Home page
 J. Appl. Physiol.Home page
A. La Gerche, A. I. MacIsaac, A. T. Burns, D. J. Mooney, W. J. Inder, J.-U. Voigt, H. Heidbuchel, and D. L. Prior
Pulmonary transit of agitated contrast is associated with enhanced pulmonary vascular reserve and right ventricular function during exercise
J Appl Physiol, November 1, 2010; 109(5): 1307 - 1317.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. T. Maeder, B. R. Thompson, H.-P. Brunner-La Rocca, and D. M. Kaye
Hemodynamic Basis of Exercise Limitation in Patients With Heart Failure and Normal Ejection Fraction
J. Am. Coll. Cardiol., September 7, 2010; 56(11): 855 - 863.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll Cardiol ImgHome page
M. Andersen, F. Gustafsson, P. L. Madsen, P. Brassard, A. S. Jensen, N. Secher, C. Hassager, N. Nordsborg, and J. E. Moller
Hemodynamic Stress Echocardiography in Patients Supported With a Continuous-Flow Left Ventricular Assist Device
J. Am. Coll. Cardiol. Img., August 1, 2010; 3(8): 854 - 859.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
J. E. Sanderson
Exercise echocardiography and the diagnosis of heart failure with a normal ejection fraction
Heart, July 1, 2010; 96(13): 997 - 998.
[Full Text] [PDF]

Home page
 HeartHome page
D. J. Holland, S. B. Prasad, and T. H. Marwick
Contribution of exercise echocardiography to the diagnosis of heart failure with preserved ejection fraction (HFpEF)
Heart, July 1, 2010; 96(13): 1024 - 1028.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
Z. B. Popovic and B. Griffin
Diastolic stress testing: a new trick to evaluate the ageing heart
Heart, June 1, 2010; 96(12): 906 - 907.
[Full Text] [PDF]

Home page
 HeartHome page
Y. T. Tan, F. Wenzelburger, E. Lee, G. Heatlie, M. Frenneaux, and J. E. Sanderson
Abnormal left ventricular function occurs on exercise in well-treated hypertensive subjects with normal resting echocardiography
Heart, June 1, 2010; 96(12): 948 - 955.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J Cardiovasc ImagingHome page
B. A. Popescu, A. Calin, C. C. Beladan, D. Muraru, M. Rosca, D. Deleanu, P. Lancellotti, F. Antonini-Canterin, G. L. Nicolosi, and C. Ginghina
Left ventricular torsional dynamics in aortic stenosis: relationship between left ventricular untwisting and filling pressures. A two-dimensional speckle tracking study
Eur Heart J Cardiovasc Imaging, June 1, 2010; 11(5): 406 - 413.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J Cardiovasc ImagingHome page
S. Marechaux, J. Terrade, F. Biausque, Y. Lefetz, R. Deturck, P. Asseman, T. H. Le Jemtel, and P. V. Ennezat
Exercise-induced functional mitral regurgitation in heart failure and preserved ejection fraction: a new entity
Eur Heart J Cardiovasc Imaging, May 1, 2010; 11(4): E14 - E14.
[Abstract] [Full Text] [PDF]

Home page
 Circ Cardiovasc ImagingHome page
D. J. Holland, S. B. Prasad, and T. H. Marwick
Prognostic Implications of Left Ventricular Filling Pressure With Exercise
Circ Cardiovasc Imaging, March 1, 2010; 3(2): 149 - 156.
[Abstract] [Full Text] [PDF]

Home page
 ANGIOLOGYHome page
A. Chockalingam, M. A. Linden, M. Del Rosario, G. Govindarajan, K. C. Dellsperger, and T. R. Thomas
Exercise and Weight Loss Improve Exercise Capacity Independent of Cardiac Function in Metabolic Syndrome
Angiology, February 1, 2010; 61(2): 192 - 197.
[Abstract] [PDF]

Home page
 Circ Heart FailHome page
S. Chattopadhyay, M. F. Alamgir, N. P. Nikitin, A. S. Rigby, A. L. Clark, and J. G.F. Cleland
Lack of Diastolic Reserve in Patients With Heart Failure and Normal Ejection Fraction
Circ Heart Fail, January 1, 2010; 3(1): 35 - 43.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
C. Tschope and W. J. Paulus
Doppler Echocardiography Yields Dubious Estimates of Left Ventricular Diastolic Pressures
Circulation, September 1, 2009; 120(9): 810 - 820.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
T. H. Marwick
The Deconvolution of Diastole
J. Am. Coll. Cardiol., June 30, 2009; 54(1): 47 - 48.
[Full Text] [PDF]

Home page
 Eur Heart J Cardiovasc ImagingHome page
L. A. Rustad, B. H. Amundsen, S. A. Slordahl, and A. Stoylen
Upright bicycle exercise echocardiography in patients with myocardial infarction shows lack of diastolic, but not systolic, reserve: a tissue Doppler study
Eur Heart J Cardiovasc Imaging, June 1, 2009; 10(4): 503 - 508.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
M. T. Maeder and D. M. Kaye
Heart Failure With Normal Left Ventricular Ejection Fraction
J. Am. Coll. Cardiol., March 17, 2009; 53(11): 905 - 918.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
J. Wang and S. F. Nagueh
Current Perspectives on Cardiac Function in Patients With Diastolic Heart Failure
Circulation, March 3, 2009; 119(8): 1146 - 1157.
[Full Text] [PDF]

Home page
 J Am Coll Cardiol ImgHome page
A. La Gerche, A. J. Taylor, and D. L. Prior
Athlete's Heart: The Potential for Multimodality Imaging to Address the Critical Remaining Questions
J. Am. Coll. Cardiol. Img., March 1, 2009; 2(3): 350 - 363.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
J-W Ha, D Choi, S Park, E-Y Choi, C-Y Shim, J-M Kim, J-A Ahn, S-W Lee, J K Oh, and N Chung
Left ventricular diastolic functional reserve during exercise in patients with impaired myocardial relaxation at rest
Heart, March 1, 2009; 95(5): 399 - 404.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart J Cardiovasc ImagingHome page
S. F. Nagueh, C. P. Appleton, T. C. Gillebert, P. N. Marino, J. K. Oh, O. A. Smiseth, A. D. Waggoner, F. A. Flachskampf, P. A. Pellikka, and A. Evangelisa
Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography
Eur Heart J Cardiovasc Imaging, March 1, 2009; 10(2): 165 - 193.
[Full Text] [PDF]

Home page
 JAMAHome page
J. Grewal, R. B. McCully, G. C. Kane, C. Lam, and P. A. Pellikka
Left Ventricular Function and Exercise Capacity
JAMA, January 21, 2009; 301(3): 286 - 294.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
G Wynn and M Burgess
Exercise echocardiography
Heart, January 1, 2009; 95(1): 83 - 83.
[Full Text] [PDF]

Home page
 ESC Textbook of Cardiovascular MedicineHome page
F. A. Flachskampf, J.-U. Voigt, and W. G. Daniel
Chapter 4 Cardiac Ultrasound
ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract] [Full Text] [PDF]

Home page
 HeartHome page
N R Van de Veire, J De Sutter, J J Bax, and J R T C Roelandt
Technological advances in tissue Doppler imaging echocardiography
Heart, August 1, 2008; 94(8): 1065 - 1074.
[Abstract] [Full Text] [PDF]

Home page
 Circ Cardiovasc ImagingHome page
T. H. Marwick and M. Schwaiger
The Future of Cardiovascular Imaging in the Diagnosis and Management of Heart Failure, Part 1: Tasks and Tools
Circ Cardiovasc Imaging, July 1, 2008; 1(1): 58 - 69.
[Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
S. J. Lester, A. J. Tajik, R. A. Nishimura, J. K. Oh, B. K. Khandheria, and J. B. Seward
Unlocking the Mysteries of Diastolic Function: Deciphering the Rosetta Stone 10 Years Later
J. Am. Coll. Cardiol., February 19, 2008; 51(7): 679 - 689.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
L. A. Pierard
Echocardiographic Monitoring Throughout Exercise: Better Than the Post-Treadmill Approach?
J. Am. Coll. Cardiol., November 6, 2007; 50(19): 1864 - 1866.
[Full Text] [PDF]

Home page
 ChestHome page
A. M. Bernheim, S. Kiencke, M. Fischler, L. Dorschner, J. Debrunner, H. Mairbaurl, M. Maggiorini, and H. P. Brunner-La Rocca
Acute Changes in Pulmonary Artery Pressures Due to Exercise and Exposure to High Altitude Do Not Cause Left Ventricular Diastolic Dysfunction
Chest, August 1, 2007; 132(2): 380 - 387.
[Abstract] [Full Text] [PDF]

Home page
 Eur Heart JHome page
G. Tumminello, P. Lancellotti, M. Lempereur, V. D'Orio, and L. A. Pierard
Determinants of pulmonary artery hypertension at rest and during exercise in patients with heart failure
Eur. Heart J., March 1, 2007; 28(5): 569 - 574.
[Abstract] [Full Text] [PDF]

Home page
 J Am Coll CardiolHome page
J. E. Sanderson
Systolic and Diastolic Ventricular Dyssynchrony in Systolic and Diastolic Heart Failure
J. Am. Coll. Cardiol., January 2, 2007; 49(1): 106 - 108.
[Full Text] [PDF]

Home page
 Eur Heart J Cardiovasc ImagingHome page
J.K. Oh
Echocardiography in heart failure: Beyond diagnosis
Eur Heart J Cardiovasc Imaging, January 1, 2007; 8(1): 4 - 14.
[Full Text] [PDF]


 
  CME Topic Collections Past Issues Search Current Issue Home

Advertisement