Article ID Journal Published Year Pages File Type
2963247 Journal of Cardiology 2012 10 Pages PDF
Abstract

SummaryObjectiveThis study attempted to determine whether exercise induced left ventricular (LV) diastolic dysfunction estimated by altered trans-mitral flow (TMF) velocity pattern after exercise is associated with increased risk of cardiac events including new-onset atrial fibrillation (AF) in elderly patients with impaired LV relaxation at rest.BackgroundDiastolic stress echocardiography has been applied to evaluate LV diastolic function during and post-exercise. Prognostic importance of exercise-induced diastolic dysfunction remains uncertain.Patients and methodsWe studied 126 patients (70 ± 5 years; 70 males) who underwent treadmill stress echocardiography. Doppler measurements were done before exercise and immediately after the post-stress image acquisition, and the ratio between early (E) and atrial (A) TMF velocities was measured. Patients with impaired LV relaxation (E/A < 1.0) at rest were studied. Altered TMF velocity pattern was present when patients with E/A < 1.0 at rest developed E/A ≥ 1.0 after exercise.Primary endpoints for follow-up were combination of major cardiac events and new-onset AF.ResultsThere were 42 patients with altered TMF velocity pattern after exercise. During the 5-year follow-up period, there were 30 cardiac events including 13 new-onset AF. Kaplan–Meier survival plot demonstrated that altered TMF velocity pattern after exercise is associated with increased risk of cardiac events (p < 0.0001) including development of new-onset AF (p = 0.0003). Cox hazard ratio analysis demonstrated that altered TMF velocity pattern after exercise was the best predictor of cardiac events (hazard ratio 3.939; 95%confidence interval 1.662–9.337; p = 0.0018).ConclusionsAltered TMF velocity pattern after exercise provides significant prognostic information for predicting cardiac events including new-onset AF in elderly patients with impaired left ventricular relaxation at rest.

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