Prognostic implications of left ventricular filling pressure with exercise

Holland, David J., Prasad, Sandhir B. and Marwick, Thomas H. (2010) Prognostic implications of left ventricular filling pressure with exercise. Circulation: Cardiovascular Imaging, 3 2: 149-156. doi:10.1161/CIRCIMAGING.109.908152

Author Holland, David J.
Prasad, Sandhir B.
Marwick, Thomas H.
Title Prognostic implications of left ventricular filling pressure with exercise
Journal name Circulation: Cardiovascular Imaging   Check publisher's open access policy
ISSN 1941-9651
Publication date 2010-03
Sub-type Article (original research)
DOI 10.1161/CIRCIMAGING.109.908152
Volume 3
Issue 2
Start page 149
End page 156
Total pages 8
Place of publication Baltimore, United States
Publisher Lippincott Williams & Wilkins
Collection year 2011
Language eng
Formatted abstract
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. Copyright © 2010 American Heart Association.
Keyword Exercise
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2011 Collection
School of Human Movement and Nutrition Sciences Publications
School of Medicine Publications
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Created: Sun, 04 Apr 2010, 00:06:36 EST