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Impaired Left and Right Ventricular Systolic and Diastolic Function in Response to Exercise in Patients with Diastolic Dysfunction
Author(s) -
Narayanan Meena,
Bamba Alyssa,
Liu Shuang,
Naqvi Tasneem Z.
Publication year - 2016
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13242
Subject(s) - cardiology , medicine , diastole , ejection fraction , exercise intolerance , blood pressure , doppler echocardiography , heart rate , pulmonary artery , heart failure
Background Diastolic dysfunction ( DD ) is associated with exercise intolerance. To evaluate mechanisms of exercise intolerance in patients with DD , we performed bicycle stress echocardiography. Method and Results Doppler measurements were performed at baseline, during exercise and recovery in 26 patients (58 ± 11 years) with DD and normal left ventricular ejection fraction and 6 normal controls (53 ± 5 years). Compared to controls, patients achieved similar target heart rates but lower MET s (5.5 ± 2 vs. 9.8 ± 3, P < 0.01) and a higher peak pulmonary artery pressure ( PAP ) at peak exercise (50 ± 13 vs. 32 ± 7 mmHg, P < 0.01) despite similar PAP at rest and similar mean blood pressure at peak exercise (110.4 ± 18.0 vs. 106.9 ± 11.4 mmHg, P = NS ). In patients versus controls, mitral E/E' was similar at baseline (10 ± 3 vs. 8 ± 1.3, P = NS ) but higher at recovery (11 ± 2 vs. 7 ± 2, P < 0.05), % mitral filling time was shorter at baseline, onset, and peak exercise, whereas % LV and RV ejection time was similar to controls throughout exercise. Compared to controls, lateral mitral annular S' (11.8 ± 2.5 cm/sec vs. 14.9 ± 1.9 cm/sec, P < 0.02) and tricuspid annular S' (14.8 ± 4.1 cm/sec vs. 19.4 ± 4.0 cm/sec, P < 0.05) were lower at peak exercise in patients. Conclusion Diastolic filling time is reduced at rest and stress while LV ejection time increases normally during exercise in DD . There is a reduced systolic reserve in LV and RV during exercise in DD . These mechanisms contribute to exercise intolerance and elevation of left atrial and PAP in patients with DD .