Dipyridamole stress echocardiography in suspected early-stage HFpEF patients demonstrated an increased E/e' ratio (10.9 vs 7.7, p<0.001) and abnormal active myocardial relaxation compared to hypertensive heart disease.
Observational (n=63)
No
Does dipyridamole stress echocardiography reveal differences in active myocardial relaxation between suspected early-stage HFpEF and hypertensive heart disease?
Dipyridamole stress echocardiography demonstrates that abnormal active myocardial relaxation drives increased left ventricular filling pressures in suspected early-stage HFpEF, distinguishing it from hypertensive heart disease.
Absolute Event Rate: 10.9% vs 7.7%
p-value: p=<0.001
Background Early-stage heart failure with preserved ejection fraction (HFpEF) is like hypertensive heart disease (HHD) at resting echocardiography, but increases left ventricular (LV) filling pressure during stress. Coronary microvascular dysfunction (CMD) is a pathogenetic mechanism of HFpEF. Whether CMD actively increases LV filling pressure when LV stiffness is not yet established at rest remains unknown. LV mechanics were evaluated using dipyridamole stress echocardiography (DipSE) in suspected early-stage HFpEF. Methods A total of 30 patients (mean age: 76 years; 80% female) with suspected early-stage HFpEF and 33 with HHD and normal NT-proBNP underwent DipSE. Systolic and diastolic indexes of LV myocardial function, particularly E/e′, isovolumic contraction and relaxation times (IVCT and IVRT), and ejection time (ET), were measured at rest and during stress. The myocardial performance index (MPI) was calculated as IVCT + IVRT/ET. Results E/e′ ratio increased in suspected early-stage HFpEF patients ( p 0.001), but not in HHD patients. During stress, the IVRT reduced in HHD patients ( p = 0.002), whereas remained significantly higher in suspected early-stage HFpEF patients ( p 0.001). Thus, MPI improved during DipSE in HHD patients ( p = 0.005), but not in suspected early-stage HFpEF patients. Particularly, MPI was worse in suspected early-stage HFpEF patients with ST-segment depression than in those without it ( p = 0.05). Conclusions In suspected early-stage HFpEF, increased LV filling pressure during DipSE is associated with abnormal active myocardial relaxation. Myocardial performance is particularly impaired in patients with ST-segment depression during DipSE.
Locorotondo et al. (2026) conducted an observational in Suspected early-stage heart failure with preserved ejection fraction (HFpEF) (n=63). Dipyridamole stress echocardiography vs. Hypertensive heart disease (HHD) was evaluated on E/e' ratio during stress (p=<0.001). Dipyridamole stress echocardiography in suspected early-stage HFpEF patients demonstrated an increased E/e' ratio (10.9 vs 7.7, p<0.001) and abnormal active myocardial relaxation compared to hypertensive heart disease.