BACKGROUND Exercise stress echocardiography (SE) is well validated for the evaluation of myocardial ischemia. Diastolic stress testing (DST) is recommended in the 2016 American Society of Echocardiography and European Association of Cardiovascular Imaging Guidelines for unexplained dyspnea. This study's aim was to prognostically evaluate the DST prospectively in a large stress testing population. METHODS Patients underwent SE with mitral E/e' measured before and after maximal treadmill exertion to estimate diastolic function. Patients were divided into four groups: group 1 (n = 201)-ischemic; group 2 (n = 1,563)-negative DST (E/e'pre < 12, E/e'post < 12); group 3 (n = 68)-positive DST (E/e'pre < 12, E/e'post ≥ 12); group 4 (n = 314)-high baseline E/e' (E/e'pre ≥ 12). RESULTS Consecutive patients (n = 2,201, 770 [35%] female; 58 ± 12 years) were followed after SE for 27,964 patient-months. Time to first heart failure event (composite of heart failure admission, worsening New York Heart Association class, worsening ejection fraction, or cardiovascular death) was analyzed and adjusted using Cox proportional hazards regression. Ischemic patients hazard ratio (HR) was 28, 95% CI, 17-44, P < .0005, for subsequent heart failure compared with negative DST patients. Nonischemic, positive DSTs were highly predictive (HR = 4.2; 95% CI, 1.6-11.0; P = .001); while high E/e'pre was not predictive (HR = 1.3; 95% CI, 0.7-2.4; P = .49) of future heart failure events. CONCLUSIONS DST differentiates heart failure prognosis in patients with induced diastolic dysfunction. Ischemia predictably portends the worst heart failure outcomes, and nonischemic, positive diastolic stress tests predicted more events compared with negative tests. These prognostic data support and add to the recommendations of the 2016 guidelines.

中文翻译：

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舒张压力测试对跑步机压力超声心动图患者的预后价值。

背景技术运动压力超声心动图（SE）已被很好地用于评估心肌缺血。对于无法解释的呼吸困难，2016年美国超声心动图学会和欧洲心血管成像协会指南推荐使用舒张压测试（DST）。这项研究的目的是在大量压力测试人群中对DST进行前瞻性评估。方法患者在最大跑步机运动前后进行二尖瓣E / e'测量的SE，以评估舒张功能。患者分为四组：第一组（n = 201）-缺血；第二组（n = 201）-缺血。第2组（n = 1,563）负DST（E / e'pre <12，E / e'post <12）；第3组（n = 68）阳性夏令时（E / e'pre <12，E / e'post≥12）；第4组（n = 314）-高基线E / e'（E / e'pre≥12）。结果连续患者（n = 2）201，770 [35％]女性；SE后随访58±12年，共27,964个患者-月。第一次心力衰竭事件的时间（心力衰竭患者的入院综合症，纽约心脏协会病情恶化，射血分数恶化或心血管死亡）的时间进行了分析，并使用Cox比例风险回归进行了调整。与阴性DST患者相比，缺血性患者继发心力衰竭的危险比（HR）为28、95％CI，17-44，P <.0005。非缺血性DST阳性具有高度预测性（HR = 4.2； 95％CI，1.6-11.0； P = 0.001）；而较高的E / e'pre不能预测未来的心力衰竭事件（HR = 1.3； 95％CI，0.7-2.4； P = 0.49）。结论DST可以区分诱发性舒张功能障碍的心力衰竭预后。缺血可能预示着最严重的心力衰竭结果，并且非缺血性，与阴性测试相比，积极的舒张压测试可以预测更多的事件。这些预后数据支持并增加了2016年指南的建议。