Diastolic function is not evaluated routinely during stress echocardiography. Little information exits regarding the incidence of diastolic dysfunction induced by exercise. The aim of this study was to assess change in diastolic function by exercise echocardiography. We hypothesized that patients with dyspnea may have higher incidence of exercise-induced diastolic dysfunction without evidence of ischemia.
We evaluated a cohort of 32 patients referred for exercise echocardiography for dyspnea. Transmitral inflow pattern and Tissue Doppler of mitral valve annulus were analyzed at rest and stress, along with evidence of ischemia.
Echocardiographic evidence of diastolic dysfunction at baseline was found in 13 patients. Out of 19 patients who had normal diastolic function at rest, 9 patients (47%) developed exercise-induced diastolic dysfunction at stress without evidence of segmental wall motion abnormality suggestive of ischemia. These patients demonstrated evidence of a relaxation abnormality with transmitral inflow pattern and Tissue Doppler of mitral valve annulus. Exercise-induced diastolic dysfunction was more prevalent in female (67%), and hypertensive patients (78%), and it was associated with reduced exercise capacity (7 METs vs. 9 METs). It was not related to age, exercise-induced ischemia or higher left ventricular diastolic pressure evaluated by the ratio of early transmitral flow velocity with the early diastolic velocity of the mitral valve annulus (E/é > 10).
Exercise-induced diastolic dysfunction in patients with dyspnea is common in female and hypertensive patients. It is not related with exercise-induced ischemia.
Exercise-induced diastolic dysfunction is common in patients who undergo stress echocardiography for symptoms of dyspnea. It should be one of the parameter evaluated during the test for these patients.
Sanjeev Patel, None.