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.