Passive Leg-Raise Is Helpful to Identify Impaired Diastolic Functional Reserve During Exercise in Patients With Abnormal Myocardial Relaxation

Background

The aim of this study was to demonstrate the usefulness of leg raise in identifying lower diastolic functional reserve to exercise.

Methods

One hundred fifty-four patients with abnormal left ventricular relaxation on Doppler mitral inflow with preserved left ventricular ejection fractions were enrolled. After resting evaluations, Doppler echocardiographic measurements were repeated during passive leg raise and graded supine bicycle exercise.

Results

Patients were divided into 3 groups according to resting E/e′ ratio and its response to leg raise: group IA (persistent E/e′ < 15 [n = 112]), group IB (change to E/e′ ≥ 15 after leg raise [n = 19]), and group II (persistent E/e′ ≥ 15 [n = 23]). Group II had lower S′, e′, and diastolic reserve index values during exercise compared with group IA but not with group IB. Group IB had higher E/e′ ratios during exercise and lower diastolic functional reserve index values accompanied by lower exercise capacity compared with group IA.

Conclusion

Passive leg raise might be helpful in identifying a subgroup with lower diastolic functional reserve and lower exercise capacity among patients with abnormal relaxation.

Keywords: Diastolic function, Relaxation, Preload, Exercise

Abbreviations: Δé_L, Change of é during leg raise, A, Late diastolic filling, á, Late diastolic velocity, DT, Deceleration time, E, Early diastolic filling, é, Early diastolic velocity, LV, Left ventricular, Ś, Systolic velocity, SV, Stroke volume