Variable Hemodynamic Responses during Diastolic Stress Echocardiography in Patients Who Have Relaxation Abnormality with Possible Elevated Filling Pressure

Background and Objectives: The clinical characteristics of patients with diastolic dysfunction characterized by a relaxation abnormality with possible elevated filling pressure is remain to be determined. We sought to test whether diastolic stress echocardiography (DSE) is useful for characterization of these patients. Methods: A total of 120 patients (58 men, mean age of $64{\pm}7years$) with E/A ratio <1.0 ($mean{\pm}SD$, $0.7{\pm}0.1$) and $10{\leq}E/e^{\prime}$ <15 at rest echocardiography was enrolled prospectively for supine bicycle exercise up to 50 W. Results: During exercise, 47 patients (39%) showed high left ventricular filling pressure ($E/e^{\prime}$ >15, hLVFP) and 40 (30%) developed exercise-induced pulmonary hypertension (systolic pulomary arterial pressure >50 mmHg, EiPH) without hLVFP. The remaining 33 patients did not show hLVFP or EiPH. The incidence of EiPH with hLVFP was 21% (25/120). By multivariate analysis, age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.00-1.13; p=0.039) and systolic pulmonary artery pressure at rest (OR, 1.14; 95% CI, 1.02-1.27; p=0.02) were associated with EiPH, whereas late diastolic transmitral velocity (OR, 1.04; 95% CI, 1.00-1.08; p=0.03) and diastolic blood pressure (OR, 0.94; 95% CI, 0.90-0.99; p=0.02) were associated with hLVFP during exercise. Conclusions: Patients with relaxation abnormality and possibly hLVFP showed markedly heterogeneous hemodynamic changes during low-level exercise and DSE was useful to characterize these patients.