Exercise-induced changes in left ventricular filling pressure after myocardial infarction assessed with simultaneous right heart catheterization and Doppler echocardiography

Abstract

Background: To assess whether changes in E/e´ (the ratio between peak early mitral inflow velocity (E) and peak early mitral annulus velocity (e´)) during exercise reflect changes in filling pressure in patients with a recent myocardial infarction (MI) and mild to moderate diastolic dysfunction at rest. A low E/e´ ratio is associated with low filling pressures while a high E/e´ ratio is associated with high filling pressures. In the intermediate range of E/e´ guidelines suggest additional measurements during exercise in order to determine filling pressures.

Methods and results: Sixty-one patients with a recent MI and left ventricular ejection fraction (LVEF) ≥ 45%, left atrium (LA)>34 ml/m(2) and E/e´ between 8 and 15, underwent simultaneous right heart catheterization and Doppler echocardiography during a symptom limited semi supine cycle exercise test. E velocity increased from 75 ± 16 to 139 ± 27 cm/s and e´ increased from 7.1 ± 1.4 to 16.1 ± 3.6 cm/s with exercise. Thus, E/e´ decreased from 10.5 ± 1.7 to 9.3 ± 2.3 while pulmonary capillary wedge pressure (PCWP) increased from 13 ± 4 to 33 ± 8 mmHg. There was no correlation between LV filling pressure and E/e´ at rest, at 4 METS, at peak exercise or 5 min after termination of exercise. Neither was there any correlation between changes in PCWP and changes in E/e´.

Conclusion: For post-MI patients with resting E/e´ in the intermediate range changes in E/e´ with physical exercise does not reflect changes in LV filling pressures.

Keywords: Exercise; Heart catheterization; Myocardial infarction; Stress echocardiography; Ventricular diastolic dysfunction.