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Low diastolic wall strain is associated with raised post-exercise E/E′ ratio in elderly patients without obvious myocardial ischemia

Journal of Echocardiography volume 12, pages 106–111 (2014)Cite this article

Abstract

Background

It has been reported that the diastolic wall strain (DWS) inversely correlates with the myocardial stiffness constant. The ratio of early diastolic transmitral flow velocity to annulus velocity (E/E′) correlates with the left ventricular (LV) filling pressure. Increased LV wall stiffness is thought be associated with increased LV filling pressure after exercise. The purpose of this study was to evaluate the correlation between the DWS and post-exercise E/E′ in elderly patients without obvious myocardial ischemia.

Methods

Fifty-eight elderly patients (age = 74 ± 6 years) who underwent treadmill stress echocardiography were studied. All patients had normal LV wall motion at rest, and patients with exercise-induced wall motion abnormality were excluded. The DWS was calculated as follows: DWS = (PWTs − PWTd)/PWTs, where PWTs is the LV posterior wall thickness at end-systole and PWTd is that at end-diastole. As previously reported, DWS ≤ 0.33 was defined as low DWS and E/E′ ≥15.0 was defined as a marker of increased LV filling pressure.

Results

Eighteen patients had low DWS. Patients with low DWS had greater post-exercise E/E′ (17.9 ± 3.2 vs. 12.8 ± 3.3, p < 0.0001). The DWS was inversely and strongly correlated with post-exercise E/E′ (r 2 = 0.534, p < 0.0001). Low DWS predicted the development of raised post-exercise E/E′ ≥15.0 with a positive predictive value of 94 % and a negative predictive value of 85 %.

Conclusion

In elderly patients without obvious myocardial ischemia, the DWS correlates strongly and inversely with post-exercise E/E′. Patients with low DWS were likely to develop raised E/E′ after exercise.

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Conflict of interest

Tsutomu Takagi has received honoraria of $1000 or less as a lecture fee from the following companies: Astellas Pharma Inc., AstraZeneca K.K., Bayer Yakuhin Ltd., Boehringer Ingelheim Japan Inc., Kowa Pharmaceutical Co., Ltd., MSD K.K., Shionogi & Co., Ltd., Novartis Pharma K.K., and Takeda Pharmaceutical Co., Ltd.

Atsushi Takagi declares that he has no conflict of interest.

Junichi Yoshikawa declares that he has no conflict of interest.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000(5). Informed consent was obtained from all patients for being included in the study.

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Affiliations

  1. Takagi Cardiology Clinic, Mibu Kayogosho-cho 3-3, Nakagyo-ku, Kyoto, 604-8811, Japan

    Tsutomu Takagi

  2. Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan

    Atsushi Takagi

  3. Nishinomiya Watanabe Cardiovascular Center, Nishinomiya, Japan

    Junichi Yoshikawa

Authors
  1. Tsutomu Takagi
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  2. Atsushi Takagi
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  3. Junichi Yoshikawa
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Correspondence to Tsutomu Takagi.

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Takagi, T., Takagi, A. & Yoshikawa, J. Low diastolic wall strain is associated with raised post-exercise E/E′ ratio in elderly patients without obvious myocardial ischemia. J Echocardiogr 12, 106–111 (2014). https://doi.org/10.1007/s12574-014-0225-1

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  • DOI: https://doi.org/10.1007/s12574-014-0225-1

Keywords

  • Diastolic wall strain
  • Tissue Doppler echocardiography
  • Diastolic stress echocardiography
  • Exercise stress echocardiography