Document Detail


Left ventricular filling pressure estimation at rest and during exercise in patients with severe aortic valve stenosis: comparison of echocardiographic and invasive measurements.
MedLine Citation:
PMID:  19269785     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The Doppler index of left ventricular (LV) filling (E/e') is recognized as a noninvasive measure for LV filling pressure at rest but has also been suggested as a reliable measure of exercise-induced changes. The aim of this study was to investigate changes in LV filling pressure, measured invasively as pulmonary capillary wedge pressure (PCWP), at rest and during exercise to describe the relation with E/e' in patients with severe aortic stenosis. METHODS: Twenty-eight patients with an aortic valve areas<1 cm(2) performed a multistage supine bicycle exercise test until exhaustion. PCWP, E/e'(septal), and E/e'(lateral) were determined simultaneously by echocardiography at rest and at maximal tolerated workload. RESULTS: PCWP increased significantly from 18+/-8 mm Hg at rest to 39+/-10 mm Hg at peak exercise (P < .0001). E, e'(septal), and e'(lateral) increased with exercise, whereas E/e'(septal) remained unchanged (19+/-6 vs 19+/-6; P=NS), and only minimal changes were observed in E/e'(lateral) (14+/-4 vs 15+/-4; P=.05). E/e'(septal) and E/e'(lateral) were significantly correlated with PCWP at rest (r=0.72, P < .0001, and r=0.67, P < .0001, respectively) as well as at peak exercise (r=0.66, P=.0003, and r=0.47, P=.02, respectively), with nearly similar slopes of the linear regression lines. The intercepts, however, increased by 18 mm Hg (P=.01) and by 19 mm Hg (P=.01) at peak exercise, respectively. Changes in E/e'(septal) and E/e'(lateral) were not related to changes in PCWP with exercise (P=NS). Instead, the ratio of E velocity during exercise to e'(septal) at rest (E(exercise)/e'(septal, rest)) was correlated with PCWP during exercise (r=0.61, P=.001), and furthermore, E(exercise)-E(rest)/e'(septal, rest) was related to changes in PCWP (r=0.45, P=.02). The results for the lateral side were r=0.50 (P=.01) and r=0.44 (P=.03), respectively. CONCLUSIONS: E/e' is well correlated with PCWP at rest. However, E/e' cannot be used to detect exercise-induced changes in PCWP in patients with severe aortic stenosis. Using the ratio of E during exercise to e' at rest may result in a better estimate of the increase in PCWP during exercise.
Authors:
Morten Dalsgaard; Jesper Kjaergaard; Redi Pecini; Kasper Karmark Iversen; Lars Køber; Jacob Eifer Moller; Peer Grande; Peter Clemmensen; Christian Hassager
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-03-09
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  22     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-06     Completed Date:  2009-07-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  343-9     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. morten.dalsgaard@rh.regionh.dk
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve Stenosis / complications*,  ultrasonography*
Blood Pressure*
Blood Pressure Determination / methods*
Echocardiography, Doppler / methods*
Exercise Test
Female
Humans
Male
Reproducibility of Results
Rest
Sensitivity and Specificity
Ventricular Dysfunction, Left / etiology*,  ultrasonography*
Comments/Corrections
Comment In:
J Am Soc Echocardiogr. 2009 Apr;22(4):350-3   [PMID:  19345304 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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