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

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 Evaluation of different late left ventricular remodeling definitions for predicting long-term outcomes in acute myocardial infarction patients undergoing percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Zhang ◽  
X Xie ◽  
C He ◽  
X Lin ◽  
M Luo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Remodeling ◽  
Cox Regression ◽  
Left Ventricular Remodeling ◽  
Left Ventricular ◽  
Long Term Outcomes ◽  
Cox Regression Analysis ◽  
Long Term Mortality

Abstract Background Late left ventricular remodeling (LLVR) after the index acute myocardial infarction (AMI) is a common complication, and is associated with poor outcome. However, the optimal definition of LLVR has been debated because of its different incidence and influence on prognosis. At present, there are limited data regarding the influence of different LLVR definitions on long-term outcomes in AMI patients undergoing percutaneous coronary intervention (PCI). Purpose To explore the impact of different definitions of LLVR on long-term mortality, re-hospitalization or an urgent visit for heart failure, and identify which definition was more suitable for predicting long-term outcomes in AMI patients undergoing PCI. Methods We prospectively observed 460 consenting first-time AMI patients undergoing PCI from January 2012 to December 2018. LLVR was defined as a ≥20% increase in left ventricular end-diastolic volume (LVEDV), or a >15% increase in left ventricular end-systolic volume (LVESV) from the initial presentation to the 3–12 months follow-up, or left ventricular ejection fraction (LVEF) <50% at follow up. These parameters of the cardiac structure and function were measuring through the thoracic echocardiography. The association of LLVR with long-term prognosis was investigated by Cox regression analysis. Results The incidence rate of LLVR was 38.1% (n=171). The occurrence of LLVR according to LVESV, LVEDV and LVEF definition were 26.6% (n=117), 31.9% (n=142) and 11.5% (n=51), respectively. During a median follow-up of 2 years, after adjusting other potential risk factors, multivariable Cox regression analysis revealed LLVR of LVESV definition [hazard ratio (HR): 2.50, 95% confidence interval (CI): 1.19–5.22, P=0.015], LLVR of LVEF definition (HR: 16.46, 95% CI: 6.96–38.92, P<0.001) and LLVR of Mix definition (HR: 5.86, 95% CI: 2.45–14.04, P<0.001) were risk factors for long-term mortality, re-hospitalization or an urgent visit for heart failure. But only LLVR of LVEF definition was a risk predictor for long-term mortality (HR: 6.84, 95% CI: 1.98–23.65, P=0.002). Conclusions LLVR defined by LVESV or LVEF may be more suitable for predicting long-term mortality, re-hospitalization or an urgent visit for heart failure in AMI patients undergoing PCI. However, only LLVR defined by LVEF could be used for predicting long-term mortality. FUNDunding Acknowledgement Type of funding sources: None. Association Between LLVR and outcomes Kaplan-Meier Estimates of the Mortality

scholarly journals Upright exercise stress echocardiography may unmask dynamic left ventricular obstruction also beyond hypertrophic cardiomyopathy

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Cotrim ◽  
H Cafe ◽  
I Goncalves ◽  
J Guardado ◽  
N Cotrim ◽  
...  
Keyword(s):  
Chest Pain ◽  
Hypertrophic Cardiomyopathy ◽  
Sudden Death ◽  
Stress Echocardiography ◽  
Continuous Wave ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Exercise Stress Echocardiography ◽  
Left Ventricular Outflow ◽  
Orthostatic Position

Abstract Background Dynamic left ventricular outflow obstruction (LVOTO) during exercise stress echocardiography (ESE) is recommended in hypertrophic cardiomyopathy (HCM) to identify the obstructive phenotype. Aim To assess left ventricular outflow gradient (LVOTG) during ESE in different conditions. Methods In a single-group, prospective, observational study, we performed peak and/or post-treadmill ESE with systematic assessment of LVOTG in the orthostatic position by continuous-wave Doppler in 1333 subjects (837 males, mean age 38,2±20 ranging from 6 to 87 years) recruited over a period of twenty years, from 2001 to 2021. Peak LVOTG ≥30 mm Hg was considered abnormal for LVOTO during ESE. We enrolled 7 different populations: asymptomatic healthy controls (n=35); HCM (n=81); genotype-positive, phenotype negative asymptomatic HCM (n=6); patients with chest pain symptoms, suspected myocardial ischemia and either normal coronary arteries (INOCA, n=131,or with very low pre-test probability of coronary artery disease (probable INOCA, n=416) and; fatigue and suspected heart failure with preserved ejection fraction (HFpEF, n=206); amateur athletes with ischemia-like ECG changes during exercise-test or symptoms such as near syncope or chest pain or dizziness (n=457); aborted sudden death and with negative screening (n=1). Results Technical success rate of LVOTG assessment was 1333/1333 at rest and at peak stress (feasibility 100%). Imaging and analysis time were <1 minute. LVOTG at rest was present in 25 pts (2.8%) of the overall population: 23 HCM, 1 INOCA, and 1 HFpEF. Overall prevalence during ESE was 432/1333 (32%). During ESE, LVOTO (see Figure 1 and 2) was 0% (0/35) in normals, 58% (47/81) in HCM (23 with obstruction at rest), 33% (2/6) in genotype-positive, phenotype negative HCM, 37% (33/131) in INOCA, 40% (135/416) in athletes and 1/1 in the patient with aborted sudden death on strenuous exercise. Conclusion LVOTO in orthostatic position is detectable during treadmill ESE in several cardiovascular conditions associated with symptoms such as dyspnea, chest pain or near syncope, and even in asymptomatic patients with genotype-positive, phenotype-negative HCM. The identification of the obstructive phenotype is easy to capture during ESE without any significant additional imaging and analysis burden and can be important also outside HCM. FUNDunding Acknowledgement Type of funding sources: None. Figure 1 Figure 2

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
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