scholarly journals Contributions of exercise stress echocardiography to the understanding of heart failure with a preserved ejection fraction

2011 ◽  
Vol 104 (4) ◽  
pp. 272
Author(s):  
C. Thebault ◽  
E. Donal ◽  
T. Simon ◽  
E. Drouet ◽  
C. Ridard ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Preserved Ejection Fraction ◽  
Exercise Stress Echocardiography

scholarly journals Pulmonary congestion during exercise stress echocardiography in ischaemic, heart failure and valvular patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Merli ◽  
A Zagatina ◽  
P.M Merlo ◽  
R Arbucci ◽  
C Borguezan Daros ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Valvular Heart Disease ◽  
Healthy Subjects ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Pulmonary Congestion ◽  
Exercise Stress Echocardiography ◽  
B Lines

Abstract Background Lung ultrasound (LUS) detects pulmonary congestion as B-lines at rest and exercise stress echocardiography (ESE). Aim To assess the prevalence of B-lines during ESE in different cardiovascular diseases. Methods We performed ESE plus LUS (4-site simplified scan) in 4419 subjects referred for semi-supine bike ESE in 28 certified centers. B-lines score ranged from 0 (normal) to 40 (severely abnormal). Stress B-lines abnormal result was ≥2 units. Six different populations were evaluated: healthy controls (n=103); chronic coronary syndromes (CCS, n=3701); heart failure with reduced ejection fraction (HFrEF, n=395); heart failure with preserved ejection fraction (HFpEF, n=70); valvular heart disease (VHD) for ischemic mitral regurgitation ≥moderate at rest (n=123); repaired tetralogy of Fallot (ToF, n=27). Results Feasibility of B-lines was 100% at rest and peak ESE in all subjects. Imaging and analysis time were <1 minute. B-lines (median) were not detectable in healthy subjects (rest=0.1 [0–1] vs 0.1 [0–1], p=ns) and TOF (rest=0.2 [0–2] vs 0.3 [0–4], p=ns), but were present in all other groups: see figure. During ESE, B-lines increased in CCS (rest=0.5 [0–24] vs ESE=1.3 [0–28], p<0.001); HFrEF (rest=1.4 [0–35] vs ESE=2.9 [0–40], p<0.001); HFpEF (rest=0.3 [0–2] vs ESE=3.4 [0–12], p<0.001), VHD (rest=1.7 [0–12] vs ESE=4.3 [0–23], p<0.001). Stress B-lines were correlated with stress-rest change in wall motion score index in CCS (r=0.325, p<0.001), contractile reserve in HFrEF (r=−0.266, p<0.001) and in VHD (r=−.0300, p=0.001), left atrial volume stress-rest change in HFpEF (r=0.287, p=0.043). Conclusion B-lines identify the pulmonary congestion phenotype at rest and more frequently during ESE in patients with different coronary, myocardial or valvular heart disease, all sharing the final common pathway of acute backward left heart failure through different disease-specific mechanisms. B-lines are absent in healthy subjects and in conditions inducing a mostly right-sided overload such as repaired ToF. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. B-lines at rest and during stress. Percentage (%) of rest (empty bar) and stress (full bar) B-lines abnormality (≥2 units) in six different study groups.

Prognostic value of peak stress cardiac power in patients with normal ejection fraction undergoing exercise stress echocardiography

2020 ◽  
Author(s):  
Vidhu Anand ◽  
Garvan C Kane ◽  
Christopher G Scott ◽  
Sorin V Pislaru ◽  
Rosalyn O Adigun ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Peak Stress ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Cardiac Power ◽  
Exercise Stress Echocardiography ◽  
Lv Mass

Abstract Aims  Cardiac power is a measure of cardiac performance that incorporates both pressure and flow components. Prior studies have shown that cardiac power predicts outcomes in patients with reduced left ventricular (LV) ejection fraction (EF). We sought to evaluate the prognostic significance of peak exercise cardiac power and power reserve in patients with normal EF. Methods and results  We performed a retrospective analysis in 24 885 patients (age 59 ± 13 years, 45% females) with EF ≥50% and no significant valve disease or right ventricular dysfunction, undergoing exercise stress echocardiography between 2004 and 2018. Cardiac power and power reserve (developed power with stress) were normalized to LV mass and expressed in W/100 g of LV myocardium. Endpoints at follow-up were all-cause mortality and diagnosis of heart failure (HF). Patients in the higher quartiles of power/mass (rest, peak stress, and power reserve) were younger and had higher peak blood pressure and heart rate, lower LV mass, and lower prevalence of comorbidities. During follow-up [median 3.9 (0.6–8.3) years], 929 patients died. After adjusting for age, sex, metabolic equivalents (METs) achieved, ischaemia/infarction on stress test results, medication, and comorbidities, peak stress power/mass was independently associated with mortality [adjusted hazard ratio (HR), highest vs. lowest quartile, 0.5, 95% confidence interval (CI) 0.4–0.6, P < 0.001] and HF at follow-up [adjusted HR, highest vs. lowest quartile, 0.4, 95% CI (0.3, 0.5), P < 0.001]. Power reserve showed similar results. Conclusion  The assessment of cardiac power during exercise stress echocardiography in patients with normal EF provides valuable prognostic information, in addition to stress test findings on inducible myocardial ischaemia and exercise capacity.

scholarly journals P1556 Significance of combined cardiopulmonary and echocardiographic stress test to distinguish the hemodynamic and metabolic responses of hypertensive patients with or without heart failure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
N R Pugliese ◽  
M Mazzola ◽  
N De Biase ◽  
A Natali ◽  
L Gargani ◽  
...  
Keyword(s):  
Heart Failure ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Cardiopulmonary Exercise Test ◽  
Exercise Stress ◽  
Metabolic Responses ◽  
Preserved Ejection Fraction ◽  
Metabolic Characteristics ◽  
Cardiopulmonary Exercise ◽  
Content Difference

Abstract Background Arterial hypertension (HT) is one of the main risk factors for the development of heart failure with preserved ejection fraction (HFpEF). However, little is known regarding the hemodynamic and metabolic responses of patients with HT during the stress test. Purpose We assessed the hemodynamic and metabolic characteristics of HT subjects and patients with HFpEF and HT (HFpEF-HT) by combining cardiopulmonary exercise test (CPET) and exercise stress echocardiography (ESE). Methods We studied 170 consecutive subjects, undergoing a symptom-limited graded ramp bicycle CPET-ESE: 52 stable (NYHA I-III) outpatients with HFpEF-HT (69 ± 13 years; 44 males, 85%), 86 well-controlled HT subjects (66 ± 10 years; 72 males, 84%) and 32 age and sex-matched healthy controls (59 ± 15 years; 24 males, 75%). During the exercise, we assessed oxygen consumption (VO2), cardiac output (CO) systemic vascular resistance (SVR) and arterial-venous oxygen content difference (AVO2diff). Results Peak systolic blood pressure was significantly more elevated in HT subjects (205.7 ± 23 mmHg) than controls (190.9 ± 29 mmHg; p = 0.005) and patients with HFpEF-HT (177.5 ± 26 mmHg; p = 0.03). HT patients exhibited a peak VO2 (18.7 ± 2 ml/min/kg) that was higher than HFpEF-HT patients (15.2 ± 2 ml/min/kg; p < 0.0001), but lower than controls (24.4 ± 7.3 ml/min/kg; p < 0.0001). Peak CO was significantly more elevated in HT (12.3 ± 0.4 ml/min) and controls (13.3 ± 0.6 ml/min) than in HFpEF-HT (9.8 ± 0.4 ml/min; p < 0.0001). Both HFpEF-HT and HT patients displayed a significantly reduced peak AVO2diff (13.3 ± 1 and 13.5 ± 1 vs 16.9 ± 1 mL/dL; p < 0.0001) and increased SVR compared to controls (1066 ± 36 and 1054 ± 33 vs 904 ± 42 dyne·s/cm; p = 0.01). Conclusions CPET-ESE was valuable to characterise the hemodynamic and metabolic responses of patients with HT (Figure). HT subjects present a decreased AVO2diff similar to HFpEF patients, suggesting an early peripheral dysfunction, probably related to the impaired reduction of SVR during exercise. Abstract P1556 Figure.

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