Abstract
This study evaluated Doppler mitral inflow variables changes from rest to post-exercise among 104 subjects with and without echocardiographic evidence of ischemic response (IR) to exercise (63.9 ± 11 years, 54% male, 32% with IR) who underwent a clinically indicated treadmill stress echo (TSE) test. The time from exercise cessation to imaging (TIME) was recorded. The changes (after TSE minus baseline values) in the peak E-wave velocity (∆E) [34.2 vs. 24.2, p = 0.024] and E-wave deceleration rate (∆DR) [348.0 vs. 225.7, p = 0.010] were bigger in ischemic than in nonischemic subjects, while the changes in the peak A-wave velocity (∆A) did not differ [7.9 vs. 15.0, p = 0.082]. The correlations between Doppler variables and IR, TIME, and TIME × IR interaction were analyzed. We observed a significant interaction between TIME and IR regarding ∆E and ∆DR. The differences in the regression line slopes of time courses for ∆E and ∆DR based on IR were significant: ∆E (− 0.09 vs. − 8.17, p = 0.037) and ∆DR (11.23 vs. − 82.60, p = 0.022). Main findings: (1) Time courses after exercise of ∆E and ∆DR in subjects with and without IR were different. (2) ∆E and ∆DR did not differ between subjects with and without IR at exercise cessation (TIME = 0). (3) The simple main effect of ischemia on ∆E and ∆DR was significant at TIME of ≥ 3 min. Divergent time courses of ∆E and ∆DR after exercise might be promising for detecting diastolic dysfunction caused by ischemia.
Graphical abstract
After the cessation of exercise, ΔE and ΔDR in nonischemic but not in ischemic subjects quickly tend to zero. The differences in ΔE and ΔDR between the two groups only became significant for TIME of ≥ 3 min. At the time of exercise cessation, the values of ΔE and ΔDR (taken from the regression lines) were not significantly different between the patients with and without IR. This divergent response is promising for detecting diastolic dysfunction caused by ischemia.
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References
Choong CY, Abascal VM, Thomas JD, Guerrero JL, McGlew S, Weyman AE (1988) Combined influence of ventricular loading and relaxation on the transmitral flow velocity profile in dogs measured by Doppler echocardiography. Circulation 78:672–683. https://doi.org/10.1161/01.cir.78.3.672
Thomas JD, Newell JB, Choong CY, Weyman AE (1991) Physical and physiological determinants of transmitral velocity: numerical analysis. Am J Physiol 260:H1718–H1731. https://doi.org/10.1152/ajpheart.1991.260.5.H1718
Quick CM, Young WL, Noordergraaf A (2001) Infinite number of solutions to the hemodynamic inverse problem. Am J Physiol Heart Circ Physiol 280:H1472–H1479. https://doi.org/10.1152/ajpheart.2001.280.4.H1472
King LM, Boucher F, Opie LH (1995) Coronary flow and glucose delivery as determinants of contracture in the ischemic myocardium. J Mol Cell Cardiol 27:701–720. https://doi.org/10.1016/s0022-2828(08)80061-2
Thomas JD, Choong CY, Flachskampf FA, Weyman AE (1990) Analysis of the early transmitral Doppler velocity curve: effect of primary physiologic changes and compensatory preload adjustment. J Am Coll Cardiol 16:644–655. https://doi.org/10.1016/0735-1097(90)90356-t
Thomas JD, Weyman AE (1992) Numerical modeling of ventricular filling. Ann Biomed Eng 20:19–39. https://doi.org/10.1007/bf02368504
Van de Werf F, Minten J, Carmeliet P, De Geest H, Kesteloot H (1984) The genesis of the third and fourth heart sounds. A pressure-flow study in dogs. J Clin Invest 73:1400–1407. https://doi.org/10.1172/JCI111344
Yamamoto K, Masuyama T, Tanouchi J, Uematsu M, Doi Y, Mano T, Hori M, Tada M, Kamada T (1993) Peak early diastolic filling velocity may decrease with preload augmentation: effect of concomitant increase in the rate of left atrial pressure drop in early diastole. J Am Soc Echocardiogr 6:245–254. https://doi.org/10.1016/s0894-7317(14)80060-6
Courtois M, Vered Z, Barzilai B, Ricciotti NA, Pérez JE, Ludbrook PA (1988) The transmitral pressure-flow velocity relation. Effect of abrupt preload reduction. Circulation 78:1459–1468. https://doi.org/10.1161/01.cir.78.6.1459
Bell SP, Fabian J, LeWinter MM (1998) Effects of dobutamine on left ventricular restoring forces. Am J Physiol 275:H190–H194. https://doi.org/10.1152/ajpheart.1998.275.1.H190
Eisman AS, Shah RV, Dhakal BP, Pappagianopoulos PP, Wooster L, Bailey C, Cunningham TF, Hardin KM, Baggish AL, Ho JE, Malhotra R, Lewis GD (2018) Pulmonary capillary wedge pressure patterns during exercise predict exercise capacity and incident heart failure. Circulation Heart Failure 11:e004750. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004750
Reddy YNV, El-Sabbagh A, Nishimura RA (2018) Comparing pulmonary arterial wedge pressure and left ventricular end diastolic pressure for assessment of left-sided filling pressures. JAMA Cardiol 3:453–454. https://doi.org/10.1001/jamacardio.2018.0318
Wolsk E, Bakkestrøm R, Thomsen JH, Balling L, Andersen MJ, Dahl JS, Hassager C, Moller JE, Gustafsson F (2017) The influence of age on hemodynamic parameters during rest and exercise in healthy individuals. JACC Heart Fail 5:337–346. https://doi.org/10.1016/j.jchf.2016.10.012
Kass DA, Bronzwaer JG, Paulus WJ (2004) What mechanisms underlie diastolic dysfunction in heart failure? Circ Res 94:1533–1542. https://doi.org/10.1161/01.RES.0000129254.25507.d6
Nikolic S, Yellin EL, Tamura K, Tamura T, Frater RW (1990) Effect of early diastolic loading on myocardial relaxation in the intact canine left ventricle. Circ Res 66:1217–1226. https://doi.org/10.1161/01.res.66.5.1217
Fraites TJ Jr, Saeki A, Kass DA (1997) Effect of altering filling pattern on diastolic pressure-volume curve. Circulation 96:4408–4414. https://doi.org/10.1161/01.CIR.96.12.4408
Nikolic SD, Tamura K, Tamura T, Dahm M, Frater RW, Yellin EL (1990) Diastolic viscous properties of the intact canine left ventricle. Circ Res 67:352–359. https://doi.org/10.1161/01.res.67.2.352
Quick CM, Berger DS, Noordergraaf A (1998) Apparent arterial compliance. Am J Physiol 274:H1393–H1403. https://doi.org/10.1152/ajpheart.1998.274.4.H1393
Braunwald E (1997) Heart disease: a textbook of cardiovascular medicine, 5th edn. Saunders, Philadelphia
Solomon SB, Nikolic SD, Glantz SA, Yellin EL (1998) Left ventricular diastolic function of remodeled myocardium in dogs with pacing-induced heart failure. Am J Physiol 274:H945–H954. https://doi.org/10.1152/ajpheart.1998.274.3.H945
Ishii K, Imai M, Suyama T, Maenaka M, Nagai T, Kawanami M, Seino Y (2009) Exercise-induced post-ischemic left ventricular delayed relaxation or diastolic stunning: is it a reliable marker in detecting coronary artery disease? J Am Coll Cardiol 53:698–705. https://doi.org/10.1016/j.jacc.2008.09.057
Nonogi H, Hess OM, Bortone AS, Ritter M, Carroll JD, Krayenbuehl HP (1989) Left ventricular pressure-length relation during exercise-induced ischemia. J Am Coll Cardiol 13:1062–1070. https://doi.org/10.1016/0735-1097(89)90261-1
Appleton CP, Jensen JL, Hatle LK, Oh JK (1997) Doppler evaluation of left and right ventricular diastolic function: a technical guide for obtaining optimal flow velocity recordings. J Am Soc Echocardiogr 10:271–292. https://doi.org/10.1016/s0894-7317(97)70063-4
Roger VL, Pellikka PA, Oh JK, Miller FA, Seward JB, Tajik AJ (1995) Stress echocardiography. Part I. Exercise echocardiography: techniques, implementation, clinical applications, and correlations. Mayo Clin Proc 70:5–15. https://doi.org/10.1016/S0025-6196(11)64659-4
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Lulić, F., Virag, Z. Doppler mitral inflow variables time course after treadmill stress echo with and without ischemic response. Int J Cardiovasc Imaging 38, 1751–1759 (2022). https://doi.org/10.1007/s10554-022-02568-1
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DOI: https://doi.org/10.1007/s10554-022-02568-1