Abstract
Tissue Doppler echocardiography has recently been introduced as a method to evaluate diastolic function by measuring diastolic mitral annular velocity. 1,2 Mitral annular velocity derived by tissue Doppler echocardiography is relatively independent of preload, and tissue Doppler echocardiography combined with transmitral flow velocity appears to provide a better estimate of left ventricular (LV) filling pressures compared with other methods, such as pulmonary venous flow pattern or preload reduction. 3 However, exerciseinduced changes in tissue Doppler echocardiography and mitral inflow velocities have not been characterized adequately. The purpose of this study was to evaluate transmitral inflow pattern and the tissue Doppler echocardiographic profile of a mitral annulus in healthy subjects during exercise; this would establish normal reference values to be used in a stress test to assess the extent of the elevation in diastolic filling pressure with exercise. ••• The study group was composed of 31 healthy subjects (13 men and 18 women, aged 59 14 years) without a history of hypertension, ischemic heart disease, cardiovascular symptoms, regular cardiac medication, or abnormal stress test results. Baseline measures of clinical characteristics, hemodynamic variables, mitral inflow, and diastolic velocities of the mitral annulus were obtained in all patients before exercise testing. This study was approved by the Mayo Foundation institutional review board. All subjects underwent a symptom-limited treadmill exercise test using the Bruce protocol. Blood pressure was obtained by a cuff sphygmomanometer at the 3-minute mark of each stage and at peak exercise. The 12-lead electrocardiogram was continuously monitored. All 2-dimensional and Doppler echocardiograms were recorded using a commercially available echocardiographic unit equipped with an imaging transducer and pulse-wave Doppler capability. Ejection fraction was calculated on the basis of 2-dimensional echocardiography and a modification of the method of
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