Rotação da ponta e retorno na DD

Measurements of LV rotation and back-rotation at 50 W of exercise. Representative cases of apical rotation curves (upper panel) and rotation velocity curves (lower panel) at 50 W exercise for Group 1 (A) and Group 2 (B). Apical back rotation at the MVO (%) was the proportion of the extent of recoiling from the peak apical rotation to the timing of the MVO. Minimal apical back-rotation velocity (degrees/s, orange arrow) and time-to-minimal apical back-rotation velocity after AVC (ms, yellow arrow) was defined from the rotational velocity vs. time curve. Apical back rotation at the MVO was greater in Case A compared with Case B. Minimal apical back-rotation velocity was lower and time-to-minimal apical back-rotation velocity after AVC was shorter in Case A compared with Case B. AVC, aortic valve closure; MVO, mitral valve opening.

Dynamic change in left ventricular apical back rotation: a marker of diastolic suction with exercise

https://doi.org/10.1093/ehjci/jex241

Conclusion

The lack of decrease in minimal LV pressure during exercise, a manifestation of impaired LV suction in early diastole, is linked closely with impaired LV apical back rotation during exercise. Dynamic changes in LV apical back rotation during exercise can be used as a non-invasive parameter of diastolic suction during exercise.

Diastolic Stress Test: Invasive and Noninvasive Testing

Highlights

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.

https://www.jacc.org/doi/full/10.1016/j.jcmg.2019.01.037

Changes of cardiac output and pulmonary capillary wedge pressure pressures (PCWP) during exercise. Patients A and B have almost identical left ventricular filling pressures and cardiac index at rest. In Patient A, there is a significant increase in cardiac index with a small change in left ventricular filling pressure (normal response), whereas in Patient B, there is a significant increase in left ventricular filling pressure but smaller increase in cardiac index during exercise.

Representative cases of left ventricular pressure (LVP) curves at rest and at maximal exercise from 2 individuals. In patient A, minimal LVP at rest was −1.0 mm Hg and decreased to −5.4 mm Hg during maximal exercise. In patient B, minimal LVP at rest was −1.0 mm Hg and increased to 15.5 mm Hg during exercise.

Ecoestresse para Diástole

https://heart.bmj.com/content/104/21/1739.full

Diastolic stress echocardiography: from basic principles to clinical applications

O Ecoestresse em bicicleta para avaliar diástole é mais rápido que ler o fluxo acima!!!

Nos casos positivos verdadeiros, é comum ver o E/e´passar dos 25 !!!