Diastolic stress echocardiography in patients with normal resting diastolic function: prognostic utility in presence and absence of myocardial ischemia

Abstract Background Abnormal diastolic response to exercise is reportedly associated with worse cardiovascular events. However, this has not been well studied in patients normal function at rest. Purpose We sought study referred for stress echocardiography (ExE) and explore its association adverse outcomes the presence absence of exercise-induced myocardial ischemia. Methods In a retrospective study, ExE assess ischemia between April 2017 December 2018 were enrolled. Patients included if they had guideline-defined rest availability full set post variables (post tissue Doppler derived septal mitral annular early velocity (e'), ratio pulsed forward flow (E) over e' (E/e') continuous wave maximum tricuspid regurgitation (TRV)). The followed median 3.4 years occurrence composite death, acute coronary syndrome, cardiac hospitalization, need follow-up testing. defined as <7 cm/s, E/e' >15, TRV >2.8 m/s. Results 492 [age: 55.7±12.9 year, 268 (54%) women, EF: 61±5.8%]. Mean achieved metabolic equivalents tasks (METs) was 9.7±3.1, total 49 (10%) evidence At rest, mean left atrial volume index 25.4±12 ml, 8±2 9.5±2.4, 2.1±0.44 Post 10±3 cm/s [<7cm/s 63 (13%)], 11.1±3.9 [>15 95 (19%)], 2.37±0.68 m/s [>2.8 152 (31%)]. Ischemic found be strongly outcome (HR: 4.46, 95% CI: 2.8 7.1, p<0.001). addition, all predicted isolation abnormal (e': 2.28, 1.4 3.7, p=0.001, E/e': 1.81; 1.15 2.84, p=0.01; TRV: 1.58, 1.17 2.13, p=0.003). When combined, however, seen only when 2 or 3 these simultaneously (Figure 1A). stratified by (figure 1B), more likely experience compared 0 1 both (p<0.001) (p=0.016). groups different their clinical profiles, profiles variables, best no variables. Conclusions baseline function, can unmask properties stratify patients' risk regardless overt Funding Acknowledgement Type funding sources: None.