572 Exercise stress echocardiography in patients with severe pulmonary hypertension. Preliminary data

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.

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Hemodynamic Mechanisms of Exercise-Induced Pulmonary Hypertension in Patients with Lymphangioleiomyomatosis: The Role of Exercise Stress Echocardiography

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2018.02.004 ◽

2018 ◽

Vol 31 (8) ◽

pp. 888-901 ◽

Cited By ~ 4

Author(s):

Andrea Sonaglioni ◽

Massimo Baravelli ◽

Roberto Cassandro ◽

Olga Torre ◽

Davide Elia ◽

...

Keyword(s):

Pulmonary Hypertension ◽

Stress Echocardiography ◽

Exercise Stress ◽

Exercise Stress Echocardiography ◽

Exercise Induced

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313 Prognostic implications of semi-supine exercise stress echocardiography for the evaluation of chest pain in the emergency room

European Journal of Echocardiography ◽

10.1016/s1525-2167(99)80089-4 ◽

1999 ◽

Vol 1 ◽

pp. S26-S26

Author(s):

P LANCELLOTTI ◽

E HOFFER ◽

H APPELTANS ◽

A GHUYSEN ◽

V DORIO ◽

...

Keyword(s):

Chest Pain ◽

Emergency Room ◽

Stress Echocardiography ◽

Exercise Stress ◽

Exercise Stress Echocardiography ◽

Prognostic Implications

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

European Heart Journal ◽

10.1093/eurheartj/ehaa941 ◽

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.

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