I use treadmill test

Hi Jose

I look for any evidence of diastolic left ventricular dysfunction on echo as this always precedes systolic dysfunction and will operate if there is such evidence with or without symptoms.

Sincerely, Alistair Royse

Thank you, Royse. In my experience, some diastolic dysfunction occur years before of systolic dysfunction or symptoms. If the left ventricle is very hypertrophic and shows reduced diameters I agree with you. If the left ventricle has normal diameters I use the treadmill test to disclose abnormal exercise tolerance or symptoms. 

In old patients I find sometime difficult