Document Detail

Noninvasive detection of exercise-induced markedly elevated left ventricular filling pressure by pulsed Doppler echocardiography in patients with coronary artery disease.
MedLine Citation:
PMID:  2816706     Owner:  NLM     Status:  MEDLINE    
To assess the accuracy of the exercise-induced decrease in the ratio of peak flow velocity in atrial systole to that in early diastole (A/E) for predicting an elevation of left ventricular filling pressure, supine bicycle ergometer exercise testing was performed in 27 consecutive patients with coronary artery disease. Doppler-derived transmitral flow velocities were recorded at rest and immediately after exercise. A/E decreased during exercise in 16 patients (group A) and increased in 11 (group B). Pulmonary artery wedge pressure (PAWP) increased notably from 7 mm Hg at rest to 26 mm Hg at peak exercise in group A (p less than 0.001). In contrast, PAWP increased slightly from 6 mm Hg to 10 mm Hg in group B (p less than 0.05). The cardiac index at peak exercise in group A was significantly lower than that in group B (p less than 0.05). These findings suggest that patients with an exercise-induced decrease in A/E might not increase their cardiac output. A significant negative correlation between PAWP and A/E was observed in patients with PAWP over 20 mm Hg (r = -0.74; p less than 0.005). The exercise-induced decrease in A/E showed a sensitivity of 100%, a specificity of 73%, and a predictive accuracy of 85% in detecting patients with PAWP over 20 mm Hg. These findings show that Doppler recordings of transmitral flow velocities during dynamic exercise can provide useful information concerning exercise-induced left ventricular dysfunction associated with markedly elevated filling pressures.
M Iwase; M Yokota; M Maeda; S Kamihara; T Miyahara; M Iwase; H Hayashi; H Saito
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American heart journal     Volume:  118     ISSN:  0002-8703     ISO Abbreviation:  Am. Heart J.     Publication Date:  1989 Nov 
Date Detail:
Created Date:  1989-12-05     Completed Date:  1989-12-05     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  947-54     Citation Subset:  AIM; IM    
First Department of Internal Medicine, Nagoya University School of Medicine, Japan.
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MeSH Terms
Cardiac Output
Coronary Circulation*
Coronary Disease / physiopathology*
Echocardiography, Doppler*
Heart / physiopathology*
Middle Aged
Pulmonary Wedge Pressure

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