Author + information
- Received September 4, 2018
- Revision received January 16, 2019
- Accepted January 16, 2019
- Published online January 6, 2020.
- aDepartment of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- bDepartment of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
- ↵∗Address for correspondence:
Dr. Otto A. Smiseth, Department of Cardiology, Oslo University Hospital, Rikshospitalet, N-0027 Oslo, Norway.
• Diastolic dysfunction is a key factor in the pathogenesis of heart failure.
• Frequently, symptoms of diastolic dysfunction occur only during exercise, as LV filling pressure is normal at rest, but increases with exercise.
• This implies that LV filling pressures should also be measured not only at rest but also during exercise.
• The diastolic stress test refers to the evaluation of diastolic function, either invasively or noninvasively, during exercise, and it will provide insights into cardiovascular hemodynamics.
• More work is needed to refine and standardize the methodology but the integration of diastolic stress testing into clinical practice will certainly enhance our understanding and better management of patients with diastolic dysfunction and exertional dyspnea.
Diastolic dysfunction is a key factor in the pathogenesis of heart failure. Around 50% of cases of heart failure, the hemodynamic correlate of which is increased left ventricular filling pressure, are caused by diastolic dysfunction in the setting of apparently normal systolic function. Due to its high prevalence, diastolic dysfunction is often recognized as an incidental finding. Many patients have Doppler echocardiographic evidence of impaired diastolic function but do not have any symptoms of heart failure at rest. In many of these patients, symptoms of diastolic dysfunction occur only during exercise, as left ventricular filling pressure is normal at rest, but increases with exercise. This implies that filling pressures should also be measured during exercise. The diastolic stress test refers to the evaluation of diastolic function, either invasively or noninvasively, during exercise. This review focuses on the clinical need for diastolic stress testing, both invasively and noninvasively.
- diastolic function
- diastolic stress test
- heart failure with preserved ejection fraction
- stress echocardiography
Dr. Ha was supported by the Bio and Medical Technology Development Program of the National Research Foundation funded by the Ministry of Science and Information Communication Technology (2016M3A9E9941746). Dr. Andersen was funded by South-Eastern Norway Regional Health Authority (project 2014068). Dr. Smiseth has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received September 4, 2018.
- Revision received January 16, 2019.
- Accepted January 16, 2019.
- 2020 American College of Cardiology Foundation
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