Doppler assessment of diastolic function at rest and during : exercise distinguishing myth from reality

Authors: Dumesnil, Jean G.Pibarot, Philippe
Abstract: In this issue of the Journal of the American Society of Echocardiography, Dalsgaard et al present an interesting study in which they correlated changes in the Doppler E/e' ratio with changes in pulmonary capillary wedge pressure (PCWP) as measured using Swan-Ganz catheters during exercise in patients with severe aortic stenosis. In most patients, PCWP was increased at rest (18 ± 8 mm Hg) and further increased to relatively high levels during exercise (39 ± 10 mm Hg). Surprisingly, however, septal and lateral E/e' ratios that were elevated at rest remained unchanged during exercise (septal, 19 ± 6 vs 19 ± 6; lateral, 14 ± 4 vs 15 ± 4). Significant and similar correlations between E/e' and PCWP were observed both at rest and during exercise, but the intercept of the correlations during exercise was much higher than at rest. These results are both challenging and interesting from two standpoints: (1) The data at rest and during exercise were obtained simultaneously with invasive measurements in a substantial number of patients, a rare and unique opportunity in the context of the current literature, and (2) the results are counter to the current paradigm, according to which the E/e' ratio would have been expected to increase in relation to the increase in filling pressures; nonetheless, the fact that it remained correlated with filling pressures but with a much higher intercept suggests that these data have an intrinsic coherence worthy of a logical explanation. Hence, the paper raises important questions and provides an opportunity to review the different paradigms associated with the Doppler echocardiographic assessment of diastolic function and filling pressures.
Document Type: Article de recherche
Issue Date: April 2009
Open Access Date: Restricted access
Document version: VoR
This document was published in: Journal of the American Society of Echocardiography, Vol. 22 (4), 350–353 (2009)
C.V. Mosby
Alternative version: 10.1016/j.echo.2009.02.014
Collection:Articles publiés dans des revues avec comité de lecture

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