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Comparison of the diastolic stress test with a combined resting echocardiography and biomarker approach to patients with exertional dyspnea: diagnostic and prognostic implications

Kosmala, W, Przewlocka-Kosmala, M, Rojek, A and Marwick, TH 2018 , 'Comparison of the diastolic stress test with a combined resting echocardiography and biomarker approach to patients with exertional dyspnea: diagnostic and prognostic implications' , JACC: Cardiovascular Imaging, no. Februa , pp. 1-10 , doi: 10.1016/j.jcmg.2017.10.008.

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Abstract

Objectives: This study sought to establish the diagnostic and prognostic value of a strategy for prediction of abnormal diastolic response to exercise (AbnDR) using clinical, biochemical, and resting echocardiographic markers in dyspneic patients with mild diastolic dysfunction.Background: An AbnDR (increase in left ventricular filling pressure) may indicate heart failure with preserved ejection fraction as the cause of symptoms in dyspneic patients, despite a nonelevated noncardiac at rest. However, exercise testing may be inconclusive in patients with noncardiac limitations to physical activity.Methods: In 171 dyspneic patients (64 ± 8 years) with suspected heart failure with preserved ejection fraction but resting peak early diastolic mitral inflow velocity/peak early diastolic mitral annular velocity ratio (E/e') 14). Patients were followed over 26.2 ± 4.6 months for endpoints of cardiovascular hospitalization and death.Results: AbnDR was present in 103 subjects (60%). Independent correlates of AbnDR were resting E/e' (odds ratio [OR]: 8.23; 95% confidence interval [CI]: 3.54 to 9.16; p 11.3 and galectin-3 Conclusions: The implementation of a 2-step algorithm (echocardiographic evaluation of resting E/e' followed by the assessment of galectin-3) may improve the diagnosis and prognostic assessment of individuals with suspected heart failure with preserved ejection fraction who are unable to perform a diagnostic exercise test.

Item Type: Article
Authors/Creators:Kosmala, W and Przewlocka-Kosmala, M and Rojek, A and Marwick, TH
Keywords: E/e′ ratio, diastole, exercise testing, galectin-3, untwisting rate
Journal or Publication Title: JACC: Cardiovascular Imaging
Publisher: Elsevier Inc.
ISSN: 1936-878X
DOI / ID Number: 10.1016/j.jcmg.2017.10.008
Copyright Information:

© 2018 by the American College of Cardiology Foundation.

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