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shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup

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World Journal of Methodology 2017年第4期7卷 117-128页

作者： Pupalan Iyngkaran Nagesh S Anavekar Christopher Neil Liza Thomas David L Hare Department of Medicine Northern Territory Medical School Flinders University Charles Darwin University Campus Department of Cardiology Northern Hospital Northern Health University of Melbourne Cardiology Unit Western Health Department of Medicine Western Precinct University of Melbourne South Western Sydney Clinical School University of New South Wales Westmead Hospital Westmead Clincal School University of Sydney Cardiovascular Research University of Mel-bourne Heart Failure Services Austin Health

The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.

关键词： Diastolic heart failure Exercise stress test Left atrium shortness of breath Work-up

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