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
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Figure 1 Representative hemodynamic and Doppler traces of a patient with normal left ventricular diastolic pressure (LVDP) at rest (A) and an increase in LVDP with exercise (B). At rest, the mean LVDP is 13.2 mm Hg and the ratio of early diastolic transmitral velocity to early diastolic tissue velocity (E/E') is 12.1. With exercise, the mean LVDP increases to 18.0 mm Hg and the E/E' increases to 17.1.
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Figure 2 (A) Changes in the ratio of early diastolic transmitral velocity to early diastolic tissue velocity (E/E') between rest and exercise in patients with normal mean left ventricular diastolic pressure (LVDP) at both rest and exercise. (B) Changes in E/E' between rest and exercise in patients with an elevated mean LVDP only during exercise. (C) Changes in E/E' between rest and exercise in patients with an elevated mean LVDP at rest.
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Figure 3 Correlation, both at rest and during exercise, between mean left ventricular diastolic pressure (LVDP) and ratio of early diastolic transmitral velocity to early diastolic tissue velocity (E/E'). Solid circles = resting data; open circles = exercise data.
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Figure 4 (A) Correlation between exercise capacity (metabolic equivalents [METs]) and the ratio of early diastolic transmitral velocity to early diastolic tissue velocity (E/E') both at rest (left) and with exercise (right). (B) Receiver-operator characteristic curve showing sensitivity and specificity of different E/E' values both at rest (left) and with exercise (right) to predict exercise capacity (<8 METs).
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Figure 5 Differences in exercise capacity by exercise ratio of early diastolic transmitral velocity to early diastolic tissue velocity according to resting pattern of diastolic filling. The numbers inside the bars indicate the number of patients in that subgroup. Open bars = exercise E/E’  10; solid bars = exercise E/E’ >10. FP = filling pressure; METs = metabolic equivalents.
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