Assessment of Diastolic Function During Exercise Echocardiography: Annulus Mitral Velocity or Transmitral Flow Pattern?

Objectives We hypothesize that the change in the left ventricular (LV) diastolic pattern (DP) may be measured with high reproducibility and correlates with exercise echocardiography (EE) better than the ratio of early LV inflow velocity to early diastolic annulus velocity (E/e′ index). Background The E/e′ index has been related to LV filling pressures but has not been compared with DP. Methods We selected 179 consecutive patients who were referred for EE. Early (E) and late (A) LV inflow velocities by conventional pulsed Doppler, and septal annulus e′ velocity by pulsed Doppler myocardial imaging were measured at rest (R) and post-exercise (PE). Results Four LV-DPs were found: abnormal relaxation (AR) at R and PE (E < A) in 110 patients; AR at PE (E > A at R; E < A at PE) in 22 patients; restrictive pattern (RP) at R and PE (E > A) in 18 patients; and RP at PE (E < A at R; E > A at PE) in 29 patients. The more accurate PE cutoff E/e′ values to predict abnormal EE, ischemic response, poor functional capacity (