Document Detail

Prognostic implications of left ventricular filling pressure with exercise.
MedLine Citation:
PMID:  20233862     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The estimation of left ventricular (LV) filling pressure from the ratio of transmitral and annular velocities (E/e') after exercise echocardiography may identify diastolic dysfunction in patients who complain of exertional dyspnea. This study sought to determine the relative contributions of exercise E/e' and ischemia to outcomes in patients referred for exercise echocardiography. METHODS AND RESULTS: Rest and exercise E/e' were obtained in 522 patients referred for exercise echocardiography, who were followed for cardiovascular death and hospitalization over a median of 13.2 months. Exercise E/e' >2 SD from normal was used to denote raised LV filling pressure with stress (n=75), and ischemia (n=250) was identified by inducible wall motion abnormalities. There were 65 cardiovascular hospitalizations during the follow-up period. Survival analysis showed patients without ischemia and with normal exercise E/e' to have a better prognosis than those with ischemia, with or without raised exercise E/e' (P=0.003) and the outcomes of patients with isolated raised exercise E/e' and isolated ischemia to be similar. Exercise E/e' was most valuable in patients with normal resting E/e'; those with elevation with exercise had a worse outcome than those with normal exercise E/e' (P=0.014). Exercise capacity (hazard ratio, 0.893; P=0.008), exercise wall motion score index (hazard ratio, 1.507; P<0.001), and exercise E/e' >14.5 (hazard ratio, 2.988; P=0.002) were independent predictors of outcome. The addition of exercise E/e' to exercise capacity and wall motion score index resulted in an increment in model power to predict adverse outcome (P=0.006). CONCLUSIONS: Exercise E/e' is associated with cardiovascular hospitalization, independent of and incremental to inducible ischemia.
David J Holland; Sandhir B Prasad; Thomas H Marwick
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  3     ISSN:  1942-0080     ISO Abbreviation:  Circ Cardiovasc Imaging     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-17     Completed Date:  2010-05-07     Revised Date:  2010-09-21    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  149-56     Citation Subset:  IM    
School of Medicine, The University of Queensland, Brisbane, Australia.
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MeSH Terms
Chi-Square Distribution
Coronary Angiography
Dyspnea / etiology,  physiopathology
Echocardiography, Stress*
Exercise Test
Exercise Tolerance
Middle Aged
Myocardial Ischemia / physiopathology,  ultrasonography
Proportional Hazards Models
Survival Analysis
Ventricular Dysfunction, Left / physiopathology*,  ultrasonography*
Ventricular Pressure*
Comment In:
Circ Cardiovasc Imaging. 2010 Sep 1;3(5):e3   [PMID:  20841551 ]

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

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