Ferrara Francesco, Carbone Andreina, Gargani Luna, Castaldo Rossana, Argiento Paola, Agoston Gergely, Citro Rodolfo, D'Agostino Anna, D'Andrea Antonello, D'Alto Michele, Franzese Monica, Ghio Stefano, Grünig Ekkehard, Guazzi Marco, Kasprzak Jarosław D, Lacava Graziella, Limongelli Giuseppe, Marra Alberto, Mazzola Matteo, Passaro Emanuela, Pugliese Nicola Riccardo, Rega Salvatore, Visco Valeria, Vriz Olga, Wierzbowska-Drabik Karina, Cittadini Antonio, Bossone Eduardo, Naeije Robert
Cardio-Thoracic-Vascular Department, University Hospital "San Giovanni Di Dio E Ruggi D'Aragona," Salerno, Italy.
Cardiology Unit, University of Campania Luigi Vanvitelli, Naples, Italy.
CJC Open. 2024 Nov 26;7(3):325-333. doi: 10.1016/j.cjco.2024.11.015. eCollection 2025 Mar.
Exercise transthoracic Doppler echocardiography (TTE) is considered suggestive of left ventricular (LV) diastolic dysfunction when the ratio of mitral Doppler E to tissue Doppler e' waves is >15 with or without a peak tricuspid regurgitation velocity (TRV) >3.4 m/s. However, these measurements may be affected by exercise intensity. The aim of the study was to define the normal limits of LV diastolic function indices during exercise TTE.
One hundred ninety-two healthy adults (47% females, aged 16-76 years) underwent resting and exercise TTE on a semirecumbent cycle ergometer. LV diastolic measurements were acquired at baseline and midlevel exercise (heart rate ≤110 bpm) fusion of E and A waves. TRV was acquired at rest and at peak exercise. The E/e' ratio was calculated with e' as the average of septal and lateral measurements.
At midlevel exercise, E/e' increased modestly from 6.3 ± 1.9 to 7.3 ± 2.3 ( < 0.001) as a function of workload and cardiac output (CO), independently of sex and age. The 95th percentile of exercise E/e' was 11.8. The slope of E/e'/CO was 0.4 ± 1.2/L/min. The slope of TRV/CO was 10.8 ± 11.5 cm/s/L/min. The upper 95% confidence interval of the E/e'/CO and TRV/CO slopes were 0.6/L/min and 13.1 cm/s/L/min, corresponding to an E/e' of 13.2 and a TRV of 3.4 m/s at a CO of 15 L/min.
In healthy adult subjects, E/e' slightly increased during midlevel exercise. Both E/e' and TRV are exercise intensity-dependent and would therefore be better expressed as a function of CO for the diagnosis of normal vs abnormal LV diastolic response to exercise.
当二尖瓣多普勒 E 波与组织多普勒 e' 波的比值＞15，无论有无三尖瓣反流峰值速度（TRV）＞3.4 m/s 时，运动经胸多普勒超声心动图（TTE）被认为提示左心室（LV）舒张功能障碍。然而，这些测量可能会受到运动强度的影响。本研究的目的是确定运动 TTE 期间左心室舒张功能指标的正常范围。
192 名健康成年人（47%为女性，年龄 16 - 76 岁）在半卧位蹬车测力计上进行静息和运动 TTE。在基线和中等强度运动（心率≤110 次/分钟）时采集左心室舒张测量值，E 波和 A 波融合。在静息和运动峰值时采集 TRV。E/e' 比值以 e' 作为间隔和侧壁测量值的平均值进行计算。
在中等强度运动时，E/e' 随工作量和心输出量（CO）适度增加，从 6.3±1.9 增至 7.3±2.3（＜0.001），与性别和年龄无关。运动 E/e' 的第 95 百分位数为 11.8。E/e'/CO 的斜率为 0.4±1.2/L/分钟。TRV/CO 的斜率为 10.8±11.5 cm/s/L/分钟。E/e'/CO 和 TRV/CO 斜率的 95%置信区间上限分别为 0.6/L/分钟和 13.1 cm/s/L/分钟，对应于心输出量为 15 L/分钟时 E/e' 为 13.2 和 TRV 为 3.4 m/s。
在健康成年受试者中，中等强度运动期间 E/e' 略有增加。E/e' 和 TRV 均依赖于运动强度，因此在诊断左心室对运动的舒张反应正常与否时，将它们更好地表示为心输出量的函数会更合适。
