Prognostic significance of incorporating exercise tissue doppler mitral annular early diastolic velocity in exercise diastolic dysfunction assessment

• Published in: Echocardiography (Mount Kisco, N.Y.) Vol. 40; no. 5; pp. 397 - 407
• Main Authors: Omar, Alaa Mabrouk Salem, Konje, Swiri, Muñoz‐Estrella, Alba, Alam, Loba, Gandhi, Kruti, Moras, Errol, Mancero, Brissete, Kaur, Arpanjeet, Zipf, Elizabeth, Meister, David, Peña, Maria, Perez‐Lizardo, Christopher, Kim, Ga Hee, Elias, Joseph, Argulian, Edgar
• Format: Journal Article
• Language: English
• Published: United States 01-05-2023
• Subjects: Adult; Aged; Diastole; diastolic stress test; Echocardiography; exercise induced diastolic dysfunction; Exercise Test; Female; Humans; Male; Middle Aged; myocardial relaxation; Prognosis; Retrospective Studies; tissue Doppler velocities; Ultrasonography, Doppler; Ventricular Dysfunction, Left - diagnostic imaging; exercise induced diastolic dysfunction; myocardial relaxation; tissue Doppler velocities; diastolic stress test
• ISSN: 0742-2822; 1540-8175
• DOI: 10.1111/echo.15568

Background
The existing algorithm for defining exercise‐induced diastolic dysfunction incorporates resting e’ velocity as a surrogate of myocardial relaxation. The additive prognostic value of incorporating post‐exercise e’ velocity in definition of exercise‐induced diastolic dysfunction is poorly studied.
Aim
To define the additive prognostic value of post‐exercise e’ septal velocity in the assessment of exercise‐induced diastolic dysfunction compared to the traditional approach.
Methods
This retrospective study included 1409 patients undergoing exercise treadmill echocardiography with available full set of diastolic variables. Doppler measures of diastolic function included resting septal e’ velocity, post‐exercise septal e’ velocity, post‐exercise E/e’ ratio, and post‐exercise tricuspid regurgitant jet velocity. Approaches incorporating resting septal e’ velocity and post‐exercise septal e’ velocity were compared in defining exercise‐induced diastolic dysfunction, and for association with adverse cardiovascular outcomes.
Results
The mean age of study subjects was 56.3 ± 16.5 years and 791 (56%) patients were women. A total of 524 patients had disagreement between resting and post exercise septal e’ velocities, and these values showed only weak agreement (kappa statistics: .28, P = .02). All categories of the traditional exercise‐induced DD approach incorporating resting septal e’ velocity witnessed reclassification when exercise septal e’ velocity was used. When both approaches were compared, increased event rates were only evident when both approaches agreed on exercise‐induced diastolic dysfunction (HR: 1.92, P < .001, 95% CI: 1.37–2.69). This association persisted after multivariable adjustment and propensity score matching for covariates.
Conclusion
Incorporation of post‐exercise e’ velocity into the set of variables defining exercise‐induced diastolic dysfunction can improve the prognostic utility of diastolic function assessment.