Department of Cardiovascular Medicine, Division of Cardiovascular Ultrasound, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Division of Cardiovascular Disease, Sejong General Hospital, Bucheon, Kyunggido, South Korea.
Curr Cardiol Rep. 2019 Aug 3;21(9):109. doi: 10.1007/s11886-019-1187-8.
Diastolic stress echocardiography may help facilitate the attribution of exertional dyspnea to cardiac and non-cardiac disease. It represents a non-invasive hemodynamic test to assess the patients with unexplained dyspnea. It can improve the diagnosis of heart failure with preserved ejection fraction (HFpEF) or diastolic heart failure.
A number of studies have validated exercise E/e' as a measure of left ventricular (LV) filling pressure against invasively measured LV filling pressure using simultaneous exercise echocardiography-catheterization studies. Addition of E/e' during exercise echocardiography improved sensitivity for diagnosis of HFpEF compared with resting assessment alone, and its specificity can be improved if tricuspid regurgitation velocity also increases above the normal range with exercise. The independent prognostic value of exercise E/e' has also been well delineated in a number of studies. Diastolic stress exercise echocardiography should be considered for all patients with unexplained or exertional dyspnea and normal diastolic filling pressure or grade 1 diastolic dysfunction on resting echocardiography. Addition of diastolic assessment with exercise echocardiography improves the sensitivity of the test in patients with dyspnea and there are sufficient data to integrate diastolic exercise test into our clinical practice.
舒张性运动超声心动图可有助于确定运动性呼吸困难是源于心脏疾病还是非心脏疾病。它是一种评估不明原因呼吸困难患者的非侵入性血流动力学试验。它可以提高射血分数保留型心力衰竭（HFpEF 或舒张性心力衰竭）的诊断率。
多项研究已经验证了运动 E/e'，即使用同步运动超声心动图-心导管术研究测量左心室（LV）充盈压的指标，与 LV 充盈压的侵入性测量值具有一致性。与单独进行静息评估相比，运动时增加 E/e'可提高 HFpEF 的诊断敏感性，如果三尖瓣反流速度随运动而超过正常范围，则可提高其特异性。运动 E/e'的独立预后价值在多项研究中也得到了很好的描述。对于所有不明原因或运动性呼吸困难且静息超声心动图显示正常舒张充盈压或 1 级舒张功能障碍的患者，应考虑进行舒张性运动超声心动图检查。在运动超声心动图中增加舒张评估可提高呼吸困难患者的检查敏感性，并且有足够的数据将舒张运动试验整合到我们的临床实践中。
