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Exercise Capacity and Left Ventricular Function

Jesús Peteiro, MD, PhD; Alberto Bouzas-Mosquera, MD
JAMA. 2009;301(22):2325-2327. doi:10.1001/jama.2009.696.
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To the Editor: Dr Grewal and colleagues1 assessed left ventricular diastolic function during exercise echocardiography in nonischemic patients with normal resting left ventricular function. The study demonstrated how resting left ventricular diastolic function parameters and exercise E/e′ predict functional capacity in these patients. However, 2 issues concern us.

First, the measurement of E/e′ at 2 to 7 minutes after cessation of exercise may not be reliable because recovery of heart rate, and therefore recovery of left ventricular diastolic function and filling pressures, may occur within 1 to 2 minutes after exercise for most patients.2 In other studies this parameter has been measured at peak exercise3 or within 1 minute after exercise.4 The merging of early and late diastolic waves either at the left ventricular inflow level or mitral annulus should be not considered an impediment because the usefulness of the E/e′ index has been demonstrated even in this condition.5


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June 10, 2009
Ali Gharavi, MD; Joseph A. Diamond, MD; Robert A. Phillips, MD, PhD
JAMA. 2009;301(22):2325-2327. doi:10.1001/jama.2009.697.
June 10, 2009
Jasmine Grewal, MD; Carolyn Lam, MD; Patricia A. Pellikka, MD
JAMA. 2009;301(22):2325-2327. doi:10.1001/jama.2009.698.
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