Top

Published in:

01-07-2011

The diastolic stress test: a new approach to an old problem

Authors: Kamran A. Shaikh, Miguel A. Quinones

Published in: Heart Failure Reviews | Issue 4/2011

Abstract

The evaluation of ischemic heart disease is the cornerstone of clinical Cardiology. Although there are many means of ischemic evaluation, all are with their own limitations. While perfusion-based studies are highly sensitive, they lack specificity. Conversely, systolic wall motion analysis with echocardiography tends to have high specificity; however, the sensitivity may be limited by short duration of systolic abnormalities when present. With the advent of Doppler echocardiography, and more specifically tissue Doppler imaging, and strain and strain rate imaging, a more comprehensive evaluation of the left ventricular function is available, including diastole. Diastolic abnormalities in the setting of ischemia are now being studied using these new parameters and have been suggested as a reliable marker of ischemia. Exercise-induced abnormalities in diastolic parameters have improved sensitivities and specificities over traditional stress testing and persist longer than systolic abnormalities. A review of the medical literature regarding the subject will be discussed here.

Zile MR, Baicu CF, Bonnema DD (2005) Diastolic heart failure: definitions and terminology. Prog Cardiovasc Dis 47(5):307–313PubMedCrossRef

Gary R, Davis L (2008) Diastolic heart failure. Heart Lung 37(6):405–416PubMedCrossRef

Keulenaer GW, Brutsaert DL (2007) Diastolic heart failure: a separate disease or selection bias? Prog Cardiovasc Dis 49(4):275–283PubMedCrossRef

Owan TE, Redfield MM (2005) Epidemiology of diastolic heart failure. Prog Cardiovasc Dis 47(5):320–332PubMedCrossRef

Gaasch WH, Levine HJ, Quinones MA, Alexander JK (1976) Left ventricular compliance: mechanisms and clinical implications. Am J Cardiol 38(5):645–653PubMedCrossRef

Redfield MM, Jacobsen SJ, Burnett JC Jr, Mahoney DW, Bailey KR, Rodeheffer RJ (2003) Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic. JAMA 289(2):194–202PubMedCrossRef

Nesto RW, Kowalchuk GJ (1987) The ischemic cascade: temporal sequence of hemodynamic, electrocardiographic and symptomatic expressions of ischemia. Am J Cardiol 59(7):23C–30CPubMedCrossRef

Schuijf JD, Shaw LJ, Wijns W, Lamb HJ, Poldermans D, de Roos A, Van der Wall EE, Bax JJ (2005) Cardiac imaging in coronary artery disease: differing modalities. Heart 91:1110–1117PubMedCrossRef

Underwood SR, Anagnostopoulos C, Cerqueira M et al (2004) Myocardial perfusion scintigraphy: the evidence. Eur J Nucl Med Mol Imaging 31(2):261–291PubMedCrossRef

10.

Chang SM, Hakeem A, Nagueh SF (2009) Predicting clinically unrecognized coronary artery disease: use of two-dimensional echocardiography. Cardiovasc Ultrasound 7:10PubMedCrossRef

11.

Pellikka PA (1997) Stress echocardiography in the evaluation of chest pain and accuracy in the diagnosis of coronary artery disease. Prog Cardiovasc Dis 39(6):523–532PubMedCrossRef

12.

Armstrong WF, Pellikka PA, Ryan T, Crouse L, Zoghbi WA (1998) Stress echocardiography: recommendations for performance and interpretation of stress echocardiography. Stress echocardiography task force of the nomenclature and standards committee of the American Society of Echocardiography. J Am Soc Echocardiog 11(1):97–104CrossRef

13.

Senior R, Monaghan M, Becher H, Mayet J, Nihoyannopoulos P (2005) British Society of Echocardiography. Stress echocardiography for the diagnosis and risk stratification of patients with suspected or known coronary artery disease: a critical appraisal. Supported by the British Society of Echocardiography. Heart 91(4):427–436

14.

Armstrong WF, Zoghbi WA (2005) Stress echocardiography: current methodology and clinical applications. J Am Coll Cardiol 45(11):1739–1747PubMedCrossRef

15.

Braunwald E (ed) (1997) Heart disease: a textbook of cardiovascular medicine, 5th edn edn. Philadelphia, W.B. Saunders Company, pp 421–438

16.

Zile MR, Baicu CF, Gaasch WH (2004) Diastolic heart failure–abnormalities inactive relaxation and passive stiffness of the left ventricle. N Engl J Med 350(19):1953–1959PubMedCrossRef

17.

Lopaschuk GD, Stanley W (1997) Glucose metabolism in the ischemic heart. Circulation 95:415–422

18.

García-Fernández MA, Azevedo J, Moreno M et al (1999) Regional diastolic function in ischemic heart disease using pulsed wave Doppler tissue imaging. Eur Heart J 20(7):476–477CrossRef

19.

Nishimura RA, Tajik AJ (1997) Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta stone. J Am Coll Cardiol 30:8–18PubMedCrossRef

20.

Ha JW, Lulic F, Bailey KR, Pellikka PA, Seward JB, Tajik AJ, Oh JK (2003) Effects of treadmill exercise on mitral inflow and annular velocities in healthy adults. Am J Cardiol 91(1):114–115PubMedCrossRef

21.

Nagueh SF, Appleton CP, Gillebert TC et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 10(2):165–193PubMedCrossRef

22.

Maurer MS, Spevack D, Burkhoff D, Kronzon I (2004) Diastolic dysfunction: can it be diagnosed by Doppler echocardiography? J Am Coll Cardiol 44(8):1543–1549PubMedCrossRef

23.

Rajiv C, Vinereanu D, Fraser AG (2004) Tissue Doppler imaging for the evaluation of patients with hypertrophic cardiomyopathy. Curr Opin Cardiol 19(5):430–436PubMedCrossRef

24.

Olson JM, Samad BA, Alam M (2008) Prognostic value of pulse-wave tissue Doppler parameters in patients with systolic heart failure. Am J Cardiol 102(6):722–725PubMedCrossRef

25.

Al-Omari MA, Finstuen J, Appleton CP, Barnes ME, Tsang TS (2008) Echocardiographic assessment of left ventricular diastolic function and filling pressure in atrial fibrillation. Am J Cardiol 101(12):1759–1765PubMedCrossRef

26.

Nagueh SF, Kopelen HA, Zoghbi WA (1995) Feasibility and accuracy of Doppler echocardiographic estimation of pulmonary artery occlusive pressure in the intensive care unit. Am J Cardiol 75(17):1256–1262PubMedCrossRef

27.

Dokainish H, Zoghbi WA, Lakkis NM, Al-Bakshy F, Dhir M, Quinones MA, Nagueh SF (2004) Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters. Circulation 109(20):2432–2439PubMedCrossRef

28.

Binanay C, Califf RM, Hasselblad V, O’Connor CM, Shah, Sopko G, Stevenson LW, Francis GS, Leier CV, Miller LW (2005) ESCAPE Investigators and ESCAPE study coordinators. Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial. JAMA 294(13):1625–1633PubMedCrossRef

29.

Nagueh SF (2009) Echocardiographic assessment of left ventricular relaxation and cardiac filling pressures. Curr Heart Fail Rep 6(3):154–159PubMedCrossRef

30.

Khouri SJ, Maly GT, Suh DD, Walsh TE (2004) A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr 17:290–297PubMedCrossRef

31.

Cosyns B, Haberman D, Droogmans S, Warzée S, Mahieu P, Laurent E, Moonen M, Hernot S, Lancellotti P (2009) Comparison of contrast enhanced three dimensional echocardiography with MIBI gated SPECT for the evaluation of left ventricular function. Cardiovasc Ultrasound 7:27PubMedCrossRef

32.

Rubinshtein R, Glockner JF, Feng D, Araoz PA, Kirsch J, Syed IS, Oh JK (2009) Comparison of magnetic resonance imaging versus Doppler echocardiography for the evaluation of left ventricular diastolic function in patients with cardiac amyloidosis. Am J Cardiol 103(5):718–723PubMedCrossRef

33.

Salerno M (2010) Multi-modality imaging of diastolic function. J Nucl Cardiol 17(2):316–327PubMedCrossRef

34.

Rathi VK, Doyle M, Yamrozik J, Williams RB, Caruppannan K, Truman C, Vido D, Biederman RW (2008) Routine evaluation of left ventricular diastolic function by cardiovascular magnetic resonance: a practical approach. J Cardiovasc Magn Reson 10(1):36PubMedCrossRef

35.

Kikkawa M, Nakamura T, Sakamoto K, Sugihara H, Azuma A, Sawada T, Okuyama C, Ushijima Y, Nishimura T (2001) Assessment of left ventricular diastolic function from quantitative electrocardiographic-gated 99mTc-tetrofosmin myocardial SPECT. Eur J Nucl Med 28:593–601PubMedCrossRef

36.

Akincioglu C, Berman SA, Nishina H, Kavanagh PB, Slomka PJ, Abidov A, Hayes S, Friedman JD, Germano G (2005) Assessment of diastolic function using 16 frame 99mTc-sestamibi gated myocardial perfusion SPECT: normal values. J Nucl Med 46(7):1102–1108PubMed

37.

Daneshvar D, Wei J, Tolstrup K, Thomson LE, Shufelt C, Merz CN (2010) Diastolic dysfunction: improved understanding using emerging imaging techniques. Am Heart J 160(3):394–404PubMedCrossRef

38.

Paelinck BP, de Roos A, Bax JJ, Bosmans JM, van Der Geest RJ, Dhondt D, Parizel PM, Vrints CJ, Lamb HJ (2005) Feasibility of tissue magnetic resonance imaging: a pilot study in comparison with tissue Doppler imaging and invasive measurement. J Am Coll Cardiol 45(7):1109–1116PubMedCrossRef

39.

Van Der Geest RJ, Reiber JH (1999) Quantification in cardiac MRI. J Magn Reson Imaging 10:602–608PubMedCrossRef

40.

Gotte MJ, Germans T, Russel IK, Zwanenburg JJ, Marcus JT, van Rossum AC, van Veldhuisen DJ (2006) Myocardial strain and torsion quantified by cardiovascular magnetic resonance tissue tagging: studies in normal and impaired left ventricular function. J Am Coll Cardiol 48(10):2001–2011CrossRef

41.

Nesbitt GC, Mankad S, Oh JK (2009) Strain imaging in echocardiography. In J Cardiovasc Imaging 25:9–22CrossRef

42.

Moonen M, Lancellotti P, Zacharakis D, Pierard L (2009) The value of 2D strain imaging during stress testing. Echocardiography 26(3):307–314PubMedCrossRef

43.

Ng AC, Sitges M, Pham PN, Tran DT, Delgado V, Bertini M, Nucifora G, Vidaic J, Allman C, Holman ER, Bax JJ, Leung DY (2009) Incremental value of 2-dimensional speckle tracking strain imaging to wall motion analysis for detection of coronary artery disease in patients undergoing dobutamine stress echocardiography. Am Heart J 158(5):836–844PubMedCrossRef

44.

Hanekom L, Cho GY, Leano R, Jeffriess L, Marwick TH (2007) Comparison of two-dimensional speckle and tissue Doppler strain measurement during dobutamine stress echocardiography: an angiographic correlation. Eur Heart J 28(14):1765–1772PubMedCrossRef

45.

Liang HY, Cauduro S, Pellikka P, Wang J, Urheim S, Yang EH, Rihal C, Belohlavek M, Khandheria B, Miller FA, Abraham TP (2006) Usefulness of two-dimensional speckle strain for evaluation of left ventricular diastolic deformation in patients with coronary artery disease. Am J Cardiol 98(12):1581–1586PubMedCrossRef

46.

Lewis JF, Verani MS, Poliner LR, Lewis JM, Raizner AE (1985) Effects of transluminal coronary angioplasty on left ventricular systolic and diastolic function at rest and during exercise. Am Heart J 109(4):792–798PubMedCrossRef

47.

Ha JW, Oh JK, Pellikka PA, Ommen SR, Stussy VL, Bailey KR, Seward JB, Tajik AJ (2005) Diastolic stress echocardiography: a novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography. J Am Soc Echocardiogr 18(1):63–68PubMedCrossRef

48.

Burgess MI, Jenkins C, Sharman JE, Marwick TH (2006) Diastolic stress echocardiography: hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise. J Am Coll Cardiol 47(9):1891–1900PubMedCrossRef

49.

Talreja D, Nishimura R, Oh J (2004) Non-invasive parameters of diastolic function reflect invasively measured filling pressures during exercise (abstr). Circulation 110 (Suppl):III474

50.

Tsougos E, Panou F, Paraskevaidis I, Dagres N, Karatzas D, Kremastinos DT (2008) Exercise-induced changes in E/E’ ratio in patients with suspected coronary artery disease. Coron Artery Dis 19(6):405–411PubMedCrossRef

51.

Paraskevaidis IA, Tsougos E, Panou F, Dagres N, Karatzas D, Boutati E, Varounis C, Kremastinos DT (2010) Diastolic stress echocardiography detects coronary artery disease in patients with asymptomatic type II diabetes. Coron Artery Dis 21(2):104–112PubMedCrossRef

52.

Reant P, Labrousse L, Lafitte S, Bordachar P, Pillois X, Tariosse L, Bonoron-Adele S, Padois P, Deville C, Roudaut R, Dos Santos P (2008) Experimental validation of circumferential, longitudinal, and radial 2-dimensional strain during dobutamine stress echocardiography in ischemic conditions. J Am Coll Cardiol 51(2):149–157PubMedCrossRef

53.

Ingul CB, Stoylen A, Slordahl SA, Wiseth R, Burgess M, Marwick TH (2007) Automated analysis of myocardial deformation at dobutamine stress echocardiography: an angiographic validation. J Am Coll Cardiol 49(15):1651–1659PubMedCrossRef

54.

Onishi T, Uematsu M, Nanto S, Morozumi T, Watanabe T, Awata M, Iida O, Sera F, Nagata S (2009) Detection of diastolic abnormality by dyssynchrony imaging: correlation with coronary artery disease in patients presenting with visibly normal wall motion. Circ J. 73(1):125–131PubMedCrossRef

55.

von Bibra H, Tuchnitz A, Klein A, Schneider-Eicke J, Schömig A, Schwaiger M (2000) Regional diastolic function by pulsed Doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing: a comparison with stress echocardiography and perfusion scintigraphy. J Am Coll Cardiol 36(2):444–452CrossRef

56.

Wang J, Abraham TP, Korinek J, Urheim S, McMahon EM, Belohlavek M (2005) Delayed onset of subendocardial diastolic thinning at rest identifies hypoperfused myocardium. Circulation 111(22):2943–2950PubMedCrossRef

57.

Voigt JU, Nixdorff U, Bogdan R, Exner B, Schmiedehausen K, Platsch G, Kuwert T, Daniel WG, Flachskampf FA (2004) Comparison of deformation imaging and velocity imaging for detecting regional inducible ischemia during dobutamine stress echocardiography. Eur Heart J 25(17):1517–1525PubMedCrossRef

58.

Ishii K, Miwa K, Sakurai T, Kataoka K, Imai M, Kintaka A, Aoyama T, Kawanami M (2008) Detection of post-ischemic regional left ventricular delayed outward wall motion or diastolic stunning after exercise-induced ischemia in patients with stable effort angina by using color kinesis. J Am Soc Echocardiogr 21(4):309–314PubMedCrossRef

59.

Ishii K, Imai M, Suyama T, Maenaka M, Nagai T, Kawanami M, Seino Y (2009) Exercise-induced post-ischemic left ventricular delayed relaxation or diastolic stunning: is it a reliable marker in detecting coronary artery disease? J Am Coll Cardiol 53(8):698–705PubMedCrossRef

60.

Bhatia RS, Tu JV, Lee DS, Austin PC, Fang J, Haouzi A, Gong Y, Liu PP (2006) Outcomes of heart failure with preserved ejection fraction in a population-based study. N Engl J Med 355(3):260–269PubMedCrossRef

61.

Franklin KM, Aurigemma GP (2005) Prognosis in diastolic heart failure. Prog Cardiovasc Dis 47(5):333–339PubMedCrossRef

62.

Skaluba SJ, Litwin SE (2005) Doppler-derived left ventricular filling pressures and the regulation of heart rate recovery after exercise in patients with suspected coronary artery disease. Am J Cardiol 95(7):832–837PubMedCrossRef

63.

Chuah SC, Pellikka PA, Roger VL, McCully RB, Seward JB (1998) Role of dobutamine stress echocardiography in predicting outcome in 860 patients with known or suspected coronary artery disease. Circulation 97(15):1474–1480PubMed

64.

Holland DJ, Prasad SB, Marwick TH (2010) Prognostic implications of left ventricular filling pressure with exercise. Circ Cardiovasc Imaging 3(2):149–156PubMedCrossRef

Title: The diastolic stress test: a new approach to an old problem
Authors: Kamran A. Shaikh
Miguel A. Quinones
Publication date: 01-07-2011
Publisher: Springer US
Published in: Heart Failure Reviews / Issue 4/2011
Print ISSN: 1382-4147
Electronic ISSN: 1573-7322
DOI: https://doi.org/10.1007/s10741-010-9217-z

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The STEP trials

Springer Medicine

The diastolic stress test: a new approach to an old problem

Abstract

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2011

Erratum to: Resveratrol and red wine, healthy heart and longevity

Novel techniques for assessment of left ventricular systolic function

A practical approach to imaging dyssynchrony for cardiac resynchronization therapy

The role of cardiac magnetic resonance imaging in the assessment of non-ischemic cardiomyopathy

Role of multimodality imaging in ischemic and non-ischemic cardiomyopathy

The role of nuclear imaging in the failing heart: myocardial blood flow, sympathetic innervation, and future applications

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page