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Prognostic significance of exercise‐induced diastolic dysfunction: A systematic review
Author(s) -
Sud Karan,
Bhatia Kirtipal Singh,
Vogel Birgit,
Bohra Chandrashekar,
Argulian Edgar
Publication year - 2020
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.14841
Subject(s) - medicine , diastole , cardiology , exercise intolerance , meta analysis , risk stratification , stress testing (software) , heart failure , adverse effect , physical therapy , blood pressure , computer science , programming language
Background Recent guidelines recommend diastolic stress testing among patients with unexplained dyspnea. Previous studies have reported exercise related change in diastolic parameters as a prognostic marker for worse outcomes. However, the role of exercise‐induced diastolic dysfunction (DD) in predicting adverse outcomes has not been fully established. Method We conducted a meta‐analysis to explore the prognostic significance of exercise‐induced DD. PUBMED/EMBASE/SCOPUS databases were searched for studies reporting adverse outcomes in patients undergoing exercise echocardiography based on diastolic response during exercise. Exercise‐induced DD was defined as an increase in E/e′ or E/A ratio with stress. Outcomes of interest were cardiovascular mortality or hospitalizations. Results A total of 8 studies were identified, including 4,462 patients who underwent exercise stress echocardiography. The follow‐up ranged from 13 months to 5 years. The major indication for stress testing was exertional dyspnea. All studies reported cardiac mortality and hospitalization in the composite outcome. Meta‐analysis conducted using random‐effects model showed that exercise‐induced DD was associated with a higher likelihood of cardiovascular mortality or hospitalization (HR = 1.32, P < .05). Significant heterogeneity was noted among the studies. Conclusions Exercise‐induced DD is associated with worse cardiovascular outcomes. Changes in echocardiographic parameters such as e′ with exercise might be useful for risk stratification and identification of high‐risk patients.