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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

Second, . . . [Full Text of this Article]

Jesús Peteiro, MD, PhD
pete@canalejo.org

Alberto Bouzas-Mosquera, MD
Department of Cardiology
Complejo Hospitalario de A Coruña
A Coruña, Spain

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