Diastolic stress echocardiography: from basic principles to clinical applications

Heart
Sandhir B PrasadJohn J Atherton

Abstract

Heart failure with preserved ejection fraction (HFpEF) looms as a major public heart challenge with increasing prevalence due to an ageing population. Diagnosis can be challenging due to non-specific symptomatology, low natriuretic peptide levels and equivocal diastology on resting echocardiography. Diastolic stress echocardiography represents a non-invasive option to refining the diagnosis in this subset of patients. Diastolic responses to exercise are most commonly measured with a non-invasive measure of left ventricular filling pressures (LVFP) estimated by the ratio of the early mitral inflow wave to early diastolic tissue velocity (E/e' ratio). This is measured pre- and post-exercise , and is highly feasible. An elevation of exercise E/e' >15 is classified as an abnormal response as per current guidelines. An alternative measure of exercise-related diastolic performance, the Diastolic Functional Reserve Index has also been proposed, but has not been as well studied as exercise E/e'. A number of studies have validated exercise E/e' as a measure of LVFP against invasively measured LVFP using simultaneous echocardiography-catheterisation studies. The independent prognostic value of exercise E/e' has also been well delineated ...Continue Reading

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Citations

Aug 2, 2019·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·E TossavainenP Lindqvist
Aug 5, 2019·Current Cardiology Reports·Kyung-Hee KimJae K Oh
Apr 8, 2020·Journal of Cardiovascular Translational Research·Yannis DimitroglouDimitris Tousoulis
May 11, 2021·European Heart Journal Cardiovascular Imaging·Marta SitgesMarc R Dweck

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