Key result
Exercise-induced abnormal PASP is linked to a ~285% higher prevalence of abnormal diastolic/systolic time ratio.
Why the study?
Pulmonary hypertension is frequently associated with diastolic filling abnormalities, but the relationship between diastolic times and exercise-induced increase in pulmonary artery pressure is unclear.
Is an abnormal exercise-induced increase in pulmonary artery pressure associated with reduced diastolic time at increasing heart rates?
Observational (n=125)
No
Is an abnormal exercise-induced increase in pulmonary artery pressure associated with reduced diastolic time at increasing heart rates?
Exercise-induced abnormal pulmonary artery systolic pressure is associated with reduced diastolic time at heart rates beyond 100 bpm, which can be non-invasively monitored using a force sensor.
Supports non-invasive diastolic time monitoring in exercise echo; leaves open prognostic value and therapeutic implications.
BACKGROUND: The degree of pulmonary hypertension is not independently related to the severity of left ventricular systolic dysfunction but is frequently associated with diastolic filling abnormalities. The aim of this study was to assess diastolic times at increasing heart rates in normal and in patients with and without abnormal exercise-induced increase in pulmonary artery pressure (PASP). METHODS: We enrolled 109 patients (78 males, age 62 ± 13 years) referred for exercise stress echocardiography and 16 controls. The PASP was derived from the tricuspid Doppler tracing. A cut-off value of PASP ≥ 50 mmHg at peak stress was considered as indicative of abnormal increase in PASP. Diastolic times and the diastolic/systolic time ratio were recorded by a precordial cutaneous force sensor based on a linear accelerometer. RESULTS: At baseline, PASP was 30 ± 5 mmHg in patients and 25 ± 4 in controls. At peak stress the PASP was normal in 95 patients (Group 1); 14 patients (Group 2) showed an abnormal increase in PASP (from 35 ± 4 to 62 ± 12 mmHg; P < 0.01). At 100 bpm, an abnormal (< 1) diastolic/systolic time ratio was found in 0/16 (0%) controls, in 12/93 (13%) Group 1 and 7/14 (50%) Group 2 patients (p < 0.05 between groups). CONCLUSION: The first and second heart sound vibrations non-invasively monitored by a force sensor are useful for continuously assessing diastolic time during exercise. Exercise-induced abnormal PASP was associated with reduced diastolic time at heart rates beyond 100 beats per minute.
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Bombardini et al. (2011) conducted an observational in Patients referred for exercise stress echocardiography (n=125). Abnormal exercise-induced increase in pulmonary artery pressure vs. Normal exercise pulmonary artery pressure and healthy controls was evaluated on Abnormal (< 1) diastolic/systolic time ratio at 100 bpm (p=<0.05). Exercise-induced abnormal pulmonary artery systolic pressure was associated with a significantly higher prevalence of an abnormal (<1) diastolic/systolic time ratio at 100 bpm compared to patients with normal PASP (50% vs 13%, p<0.05).
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