Cor Vasa 2010, 52(3):162-167 | DOI: 10.33678/cor.2010.043

The role of exercise echocardiography in the diagnosis of heart failure with preserved left ventricular ejection fraction (primary diastolic heart failure)

Jaroslav Meluzin

1^st Department of Internal Medicine/Cardioangiology, St. Anne's University Hospital, Masaryk University, Brno, Czech Republic

The purpose of this review article is to provide data on the role of exercise echocardiography in the diagnosis of heart failure with preserved left ventricular ejection fraction (primary diastolic heart failure). Diastolic heart failure (DHF) accounts for 30%-50% of all cases of heart failure and has a poor prognosis. The main abnormality in DHF is an increase in left ventricular filling pressure (LVFP) as a consequence of increased LV stiffness. Current guidelines defining DHF based only on resting hemodynamic values do not allow diagnosing DHF in patients whose signs (dyspnea most often) and pathological values are confined to exercise only. Recently, one quarter to one third of DHF patients have been found to show elevated LVFP only during exercise. Diastolic exercise echocardiography enables us to reveal this latent, only exercise-induced DHF by measuring the ratio of early diastolic transmitral flow velocity to early diastolic mitral annular velocity (E/Ea). An exercise-induced increase in E/Ea > 13 predicts an elevated LVFP with a sensitivity of 73% and a specificity of 96%. However, as not all studies have confirmed the accuracy of E/Ea in predicting the exercise-induced increase in LVFP and the numbers of patients studied are small, caution needs to be exercised when interpreting the results of exercise tests. Further studies are warranted to confirm the current parameters or to identify new ones to allow accurately establishing the diagnosis of exercise-induced DHF.

Keywords: Exercise echocardiography; Diastolic heart failure

Published: March 1, 2010  Show citation