1. Diastolic stress testing is indicated in patients with dyspnea and grade 1 diastolic dysfunction at rest. It is performed using supine bike or treadmill stress testing.
2. At rest, mitral E and annular e' velocities should be recorded, along with the peak velocity of TR jet from multiple windows. The same parameters are recorded during exercise or 1 to 2 min after termination of exercise when E and A velocities are not merged, because increased filling pressures usually persist for few minutes.
3. The test is considered positive when all of the following three conditions are met during exercise: average E/e' > 14 or septal E/e' ratio > 15, peak TR velocity > 2.8 m/sec and septal e' velocity < 7 cm/sec.