scholarly journals Evaluation of right ventricular contractile reserve with exercise stress echocardiography

2019 ◽  
Vol 11 (3) ◽  
pp. e325-e326
Author(s):  
A. Missana ◽  
M. Azzolini-Jacquin ◽  
C. David ◽  
D. Baudouy ◽  
B. Sartre ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Contractile Reserve ◽  
Exercise Stress Echocardiography

scholarly journals P941 Evaluation of right ventricular contractile reserve with exercise stress echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Missana ◽  
M Azzolini Jacquin ◽  
C David ◽  
D Baudouy ◽  
B Sartre ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Control Group ◽  
Contractile Reserve ◽  
Peak Strain ◽  
Systolic Strain ◽  
Peak Systolic Strain ◽  
Exercise Stress Echocardiography ◽  
Rv Function

Abstract INTRODUCTION Right ventricular (RV) contractile reserve reflects the ability of the RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. We aimed, using exercise stress echocardiography (ESE), to assess different RV contractile reserve evaluation methods in a cohort of PAH patients and controls. METHODS We prospectively included 12 patients with PAH and 12 healthy volunteers. An ESE (using tilt-table ergometer) was performed in all patients to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. 3D RV function as well as peak systolic strain, pulmonary pressures, TAPSE, pulmonary TVI and pulmonary output (using the right ventricular outflow tract diameter) were assessed in all patients. RESULTS Our patient group was composed by PAH patients, 61.5 ± 14.8 years; mean age of our control group was 29.33 ± 5.5 years. PAH patients achieved an exercise with a mean workload of 69.17 ± 26.4 Watts. There was no complication after the exercise test in all patients. Change in TAPSE was not significantly different between patients and controls (p = 0.17), whereas change in pulmonary TVI, pulmonary output and RV peak systolic strain was highly discriminant (respectively p = 0.03, p = 0.009 and p = 0.0009). Regarding RV contractile reserve parameters, RV end-systolic pressure area ratio (peak/rest) was not statistically different between controls and patients (p = 0.14) whereas change in TAPSE/sPAP, RV peak strain/sPAP, 3D RV EF/sPAP were significantly different (p = 0.005, p= 0.0008, p = 0004). CONCLUSION Changes in pulmonary output, RV peak systolic strain as well as changes in TAPSE/sPAP but mainly RV peak strain/sPAP, 3D RV EF/sPAP represent consistent and feasible tools to assess RV contractile reserve. echocardiographic parameters PAH (n = 12) Healthy Controls (n = 12) p value sPAP at rest (mmHg) 40.91 ± 10.7 15.42 ± 4.1 <0.001 sPAP at peak (mmHg) 82.50 ± 21.7 42.50 ± 17.8 <0.001 TAPSE at rest/sPAP at rest (mm/mmHg) 0.62 ± 0.2 1.72 ± 0.6 <0.001 TAPSE at peak /sPAP at peak 0.36 ± 0.1 0.80 ± 0.2 <0.001 ΔStrain (%) 3.43 ± 3.1 8.08 ± 2.8 <0.001 Δ(peak Strain/sPAP) -0.17 ± 0.2 -0.77 ± 0.4 <0.001 Δpulmonary TVI (cm) 3.88 ± 4.0 7.46 ± 3.5 0.03 Δ(RVEF/sPAP) -0.34 ± 0.4 -2.06 ± 1.7 <0.001 Abstract P941 Figure. echography (rest/peak) PAH patient

scholarly journals Evaluation of right ventricular contractile reserve with exercise stress echocardiography

2020 ◽  
Vol 12 (1) ◽  
pp. 69
Author(s):  
A. Missana ◽  
M. Azzolini-Jacquin ◽  
C. David ◽  
D. Baudouy ◽  
B. Sartre ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Contractile Reserve ◽  
Exercise Stress Echocardiography

The Clinical Significance and advantages of Stress Echocardiography in patients with moderate to severe aortic stenosis

2021 ◽  
pp. 18-24
Author(s):  
S. Yu. Bartosh-Zelenaya ◽  
T. V. Naiden ◽  
A. E. Andreeva ◽  
V. V. Stepanova
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Clinical Significance ◽  
Stress Echocardiography ◽  
Contractile Function ◽  
Stress Test ◽  
Global Longitudinal Strain ◽  
Exercise Stress ◽  
Contractile Reserve ◽  
Exercise Stress Echocardiography

In order to determine the clinical significance of exercise stress echocardiography in patients with severe to moderate aortic stenosis, a stress-induced increase in the mean pressure gradient across the aortic valve was recorded and myocardial contractile reserve was assessed using a number of parameters (ejection fraction, global longitudinal strain, elasticity index). It was found that, with normal values of EF at rest in patients with severe and moderate aortic stenosis, the deficit in contractile function was revealed using the GLS index, which demonstrated a decrease in both groups at the peak of exercise. A decrease in contractile reserve by both parameters (EF and GLS) was found in the group of patients with severe AS, which, combined with a significant stress-induced increase in the gradient on the aortic valve (≥18–20 mm Hg), an increase in pulmonary artery pressure (>  60 mm Hg) and decrease in systemic systolic blood pressure (>20 mm Hg) should be considered as a predictors of a poor prognosis of the natural course of aortic valve disease, and patients with similar stress test results should be possible candidates for surgical aortic valve replacement. A decrease in the in the LV elasticity index augmentation at the peak of exercise, strongly correlated with changes in other considered parameters of contractility and the metabolic power of exercise (MET), significantly complements the functional characteristics of the lesion for choosing the optimal management strategy. Consequently, exercise stress echocardiography is an indispensable diagnostic tool for determining the prognosis and timing of surgery in patients with aortic stenosis.

scholarly journals Exercise stress echocardiography of the pulmonary circulation and right ventricular-arterial coupling in healthy adolescents

2020 ◽  
Author(s):  
Kevin Forton ◽  
Yoshiki Motoji ◽  
Sergio Caravita ◽  
Vitalie Faoro ◽  
Robert Naeije
Keyword(s):  
Young Adults ◽  
Right Ventricular ◽  
Pulmonary Circulation ◽  
Vascular Function ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Systolic Pulmonary Artery Pressure ◽  
Middle Aged ◽  
Exercise Stress Echocardiography ◽  
Middle Aged Adults

Abstract Aims  To explore the effects of age and sex in adolescents vs. young or middle-aged adults on pulmonary vascular function and right ventricular-arterial (RV-PA) coupling as assessed by exercise stress echocardiography. Methods and results  Forty healthy adolescents aged 12–15 years were compared with 40 young adults aged 17–22 years and 40 middle-aged adults aged 30–50 years. Sex distribution was equal in the three groups. All the subjects underwent an exercise stress echocardiography. A pulmonary vascular distensibility coefficient α was determined from multipoint pulmonary vascular pressure–flow relationships. RV-PA coupling was assessed by the tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (PASP) ratio, who has been previously validated by invasive study. While cardiac index and mean PAP were not different, adolescents compared to young and middle-aged adults, respectively had higher pulmonary vascular distensibility coefficients α (1.60 ± 0.31%/mmHg vs. 1.39 ± 0.29%/mmHg vs. 1.20 ± 0.35%/mmHg, P < 0.00001). Adolescents and young adults compared to middle-aged adults, respectively had higher TAPSE/PASP ratios at rest (1.24 ± 0.18 mm/mmHg and 1.22 ± 0.17 mm/mmHg vs. 1.07 ± 0.18 mm/mmHg, P < 0.008) and during exercise (0.86 ± 0.24, 0.80 ± 0.15 and 0.72 ± 0.15 mm/mmHg, P < 0.04). The TAPSE/PASP ratio decreased with exercise. There were no sex differences in α or TAPSE/PASP. Conclusion  Compared to adults, adolescents present with a sex-independent more distensible pulmonary circulation. Resting and exercise RV-PA coupling is decreased in middle-aged adults.

scholarly journals Force-based left ventricular contractile reserve predicts outcome in patients with exercise stress echocardiography without regional wall motion abnormalities

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
DML Diego Maximiliano Lowenstein ◽  
RA Rosina Arbucci ◽  
PM Pablo Merlo ◽  
LM Liliana Martinez ◽  
NG Natalio Gastaldello ◽  
...  
Keyword(s):  
Stress Echocardiography ◽  
Cox Regression ◽  
Event Rate ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Contractile Reserve ◽  
Private Company ◽  
Exercise Stress Echocardiography

Abstract Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Investigaciones Médicas, Cardiodiagnostic Introduction. The behavior of the ejection fraction (EF) during exercise stress echocardiography (ESE) is used to measure the left ventricular (LV) contractile reserve (CR). Ventricular Elastance or Force defined as the ratio between systolic blood pressure (SBP) and LV end-systolic volume (ESV) could be better as it is less dependent of heart rate, preload, and afterload conditions. Objective. To establish the relative prognostic value of EF-based and novel Force-based LVCR in patients (pts) without ischemia during ESE. Materials and methods. In a retrospective analysis of prospectively enrolled pts, we enrolled  904 pts, (61.92 ± 12.59 years, 509 men, 56.3%) with negative ESE for RWMA. LV volumes were measured with biplane Simpson’s rule. LVCR was assessed based on EF ≥5 points increase at peak over rest and based on Force peak/rest ratio > 2. The average follow-up was 17.7 ± 5.44 months. Major cardiovascular event was defined as: death, acute myocardial infarction, cerebrovascular accident and/or need for hospitalization due to cardiovascular causes. Results. LVCR by EF was present in 536 (59.3%) and absent in 368 (40.7%) pts. LVCR by Force was present in 200 pts (22.1%) and absent in 704 pts (77.9%) pts. The overall concordance between LVCR assessed by EF and Force was 538 pts (89.6%) with presence of CR by EF and not by Force being the most frequent source of discrepant result in 336 pts.  In the long-term follow up, 52 pts experienced events: 0 all-cause death, 3 acute myocardial infarctions, 5 cerebrovascular accidents and 44 for hospitalization due to cardiovascular causes. Lack of LVCR based on EF identified patients at higher risk (see Figure) but Force-based LVCR allowed to further separate  patients with EF-based LVCR  (n = 536) into a lower risk with (n = 200, event rate 2%) and higher risk subgroup without Force-based LVCR  (n= 336, event rate 5.3 %, p<.01 vs subgroup with Force-based LVCR)  Cox Regression model identified Force-based LVCR  was the only predictor of events (HR: 3.22, 95% CI 1.83-5.6, p < 0.001). Conclusions. In patients with negative SE for RWMA, the evaluation of LVCR based on EF allows a better stratification of outcome, which is further refined by addition of Force-based LVCR, especially useful in the subset with LVCR by EF not confirmed by Force. Force-based LVCR allowed to identify a subgroup of worse long-term prognosis outperforming EF-based LVCR. Abstract Figure. LVCR by EF and Event Free Survival

scholarly journals Pulmonary hypertension subjects exhibit right ventricular transient exertional dilation during supine exercise stress echocardiography

2019 ◽  
Vol 9 (2) ◽  
pp. 204589401985190 ◽  
Author(s):  
Rama El-Yafawi ◽  
David Rancourt ◽  
Melkon Hacobian ◽  
Dennis Atherton ◽  
Mylan C. Cohen ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Healthy Controls ◽  
Ventricular Size ◽  
Basal Diameter ◽  
Exercise Stress Echocardiography ◽  
Right Ventricular Size ◽  
Longitudinal Diameter

Pulmonary hypertension is a condition with high morbidity and mortality. Resting transthoracic echocardiography is a pivotal diagnostic and screening test for pulmonary hypertension. The role of exercise stress echocardiography in the diagnosis of pulmonary hypertension is not well-established. We studied right ventricular size changes during exercise using exercise stress echocardiography to assess differences between normal and pulmonary hypertension patients and evaluate test safety, feasibility, and reproducibility. Healthy control and pulmonary hypertension patients performed recumbent exercise using a bicycle ergometer. Experienced echocardiography sonographers recorded the following resting and peak exercise right ventricular parameters using the apical four chamber view: end-diastolic area; end-systolic area; mid-diameter; basal diameter; and longitudinal diameter. Two cardiologists masked to clinical information subsequently analyzed the recordings. Parameters with acceptable inter-rater reliability were analyzed for statistical differences between the normal and pulmonary hypertension patient groups and their association with pulmonary hypertension. We enrolled 38 healthy controls and 40 pulmonary hypertension patients. Exercise stress echocardiography testing was found to be safe and feasible. Right ventricular size parameters were all readily obtainable and all had acceptable inter-observer reliability except for right ventricular longitudinal diameter. During exercise, healthy controls demonstrated a decrease in right ventricular end-systolic area, end-diastolic area, mid-diameter, and basal diameter ( P < 0.05). Conversely, pulmonary hypertension patients demonstrated an increase in right ventricular end-systolic area, end-diastolic area, and mid-diameter ( P < 0.05). These changes were unaffected by multivariate corrections. The sensitivity for pulmonary hypertension of an increase in right ventricular size was 97.2% with a negative predictive value of 95.2%. The ROC C-statistic for increase in right ventricular size was 0.93. This transient exertional dilation (TED) of the right ventricle is observed in pulmonary hypertension patients but not in healthy controls. Recumbent right ventricular exercise stress echocardiography is a feasible and safe diagnostic test for pulmonary hypertension which warrants additional study.

Sign in / Sign up

Export Citation Format

Share Document