Original articleEstimation of Left Ventricular Filling Pressure with Exercise by Doppler Echocardiography in Patients with Normal Systolic Function: A Simultaneous Echocardiographic–Cardiac Catheterization Study
Section snippets
Methods
From May 2002 through June 2004, 12 patients with ejection fraction greater than 50% and exertional dyspnea (New York Heart Association class II-III) were prospectively recruited. The inclusion criteria were: (1) age 40 years or older; (2) clinically indicated right heart catheterization; and (3) LV ejection fraction greater than 50%. The exclusion criteria were: (1) more than moderate valvular heart disease or a mitral prosthesis; (2) chronic obstructive lung disease (forced expiratory volume
Results
The clinical, echocardiographic, and catheterization parameters are summarized in Table. The transmitral E velocity increased from 0.88 ± 0.2 to 1.29 ± 0.4 cm/s whereas the mitral annular e’ velocity increased from 0.08 ± 0.02 to 0.11 ± 0.06 with exercise. The E/e’ ratio increased from 11.7 ± 0.5 to 14.4 ± 0.6. The PAWP increased from 14 ± 4 to 23 ± 10 mm Hg at peak exercise.
The noninvasively derived E/e’ versus PAWP for all patients at baseline and peak exercise measurements is shown in Figure.
Discussion
Patients with normal systolic function and hypertension or LV hypertrophy may have limiting symptoms of dyspnea with exertion as a result of diastolic dysfunction.7, 8, 9 Their diastolic filling can be compensated in the baseline state, without rest symptoms. However, during exercise, they are unable to increase cardiac output without an abnormal elevation in left atrial pressure because of the inability of the LV to enhance its diastolic filling. Invasive catheterization studies have
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Supported by a postdoctoral fellowship grant from the American Heart Association.