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Prognostic implications of left ventricular filling pressure with exercise

Citation

Holland, DJ and Prasad, SB and Marwick, TH, Prognostic implications of left ventricular filling pressure with exercise, Circulation. Cardiovascular Imaging, 3, (2) pp. 149-156. ISSN 1941-9651 (2010) [Refereed Article]


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Copyright Statement

Copyright 2010 American Heart Association, Inc.

DOI: doi:10.1161/CIRCIMAGING.109.908152

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.

Item Details

Item Type:Refereed Article
Keywords:exercise, echocardiography, diastole, ischemia, prognosis
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, TH (Professor Tom Marwick)
ID Code:90882
Year Published:2010
Web of Science® Times Cited:48
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-04-30
Last Modified:2014-05-16
Downloads:182 View Download Statistics

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