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

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 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

Impact of right ventricular contractile reserve on exercise capacity in patients with heart failure: clinical application of low-load exercise stress echocardiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Kinoshita ◽  
K Inoue ◽  
Y Akazawa ◽  
H Nakagawa ◽  
Y Sasaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Exercise Capacity ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Contractile Reserve ◽  
Peak Vo2 ◽  
Patients With Heart Failure ◽  
Low Load ◽  
Rv Function

Abstract Background The peak oxygen uptake (VO2) evaluated by the cardiopulmonary exercise test (CPX) is an established marker of exercise capacity in patients with heart failure (HF). In particular, peak VO2 <14 ml/kg/min is used to be one of the criteria for heart transplantation. However, given exercise intolerance in patients with HF, it is difficult for refractory HF patients to reach sufficient exercise load. A recent report has highlighted significant impact of right ventricular (RV) function on mortality and urgent heart transplantation. Taken together, we hypothesized that the assessment of RV function was helpful to predict exercise capacity by using low-load exercise stress echocardiography (low-load ESE) in patients with HF. Purpose We evaluated whether RV dysfunction assessed by the low-load ESE determined a low peak VO2 <14 ml/kg/min in patients with HF. Methods We studied 67 consecutive hospitalized patients with HF (mean age, 65 years; 75% male; mean LV ejection fraction, 36%) who underwent ESE and CPX after stabilized HF condition, and the time interval of CPX and ESE tests was within 48 hours. CPX was performed using an upright cycle ergometer by a ramp protocol, while ESE was performed using ergometer in semi-supine position and the workload was generally increased by 25 watts every 3 minutes. The low-load ESE was defined as the 25 watts exercise. The increments of RV s' velocity at tricuspid annulus and RV strain in the free wall were considered as a preservation of RV contractile reserve. Among the study population, 26 patients were performed right heart catheterization and RV dP/dt/Pmax was estimated as an invasive marker of RV contractility. Results The achieved intensity of exercise was 50.4±21.0 watts, and all patients completed the low-load ESE. The invasive study showed that the change of RV s' velocity during the low-load ESE significantly correlated with RV dP/dt/Pmax (r=0.706, p<0.001). As shown in Figure, the non-invasive parameters of RV contractile reserve during the low-load ESE were significantly correlated with peak VO2 (RV s' velocity: r=0.787, p<0.001; RV strain: r=0.244, p=0.047). ROC analysis showed that the change of RV s' velocity during the low-load ESE correctly identified patients with peak VO2 <14 ml/kg/min (AUC=0.95, sensitivity 92.3%, specificity 85.2%). In terms of inter- and intra-observer variabilities, ICCs of the change of RV s' velocity were 0.86 and 0.96, and ICCs of the changes of RV strain were 0.63 and 0.70, respectively. Conclusion The change of RV s' velocity during the low-load ESE could determine exercise tolerance in patients with HF. The assessment of RV contractile reserve might be clinically useful to discriminate high risk HF patients. Figure 1 Funding Acknowledgement Type of funding source: None

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 Lipopolysaccharide acutely suppresses right-ventricular strain in rats with pulmonary artery hypertension

2017 ◽  
Vol 8 (1) ◽  
pp. 204589321774450 ◽  
Author(s):  
Junjie Zhang ◽  
Yanan Cao ◽  
Xiaowei Gao ◽  
Maoen Zhu ◽  
Zhong Zhang ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Strain Rate ◽  
Acute Inflammation ◽  
Pulmonary Artery Hypertension ◽  
Left Ventricular ◽  
Systolic Strain ◽  
Peak Systolic Strain ◽  
Strain And Strain Rate ◽  
Rv Function

Worsening right ventricular (RV) dysfunction in the presence of pulmonary artery hypertension (PAH) increases morbidity and mortality in this patient population. Transthoracic echocardiography (TTE) is a non-invasive modality to evaluate RV function over time. Using a monocrotaline-induced PAH rat model, we evaluated the effect of acute inflammation on RV function. In this study, both PAH and control rats were injected with Escherichia coli lipopolysaccharide (LPS) to induce an acute inflammatory state. We evaluated survival curves, TTE parameters, and inflammatory markers to better understand the mechanism and impact of acute inflammation on RV function in the presence of PAH. The survival curve of the PAH rats dropped sharply within 9 h after LPS treatment. Several echocardiographic parameters including left ventricular (LV) stroke volume, RV tricuspid annular plane systolic excursion, RV longitudinal peak systolic strain, and strain rate decreased significantly in PAH rats before LPS injection and 2 h after LPS injection. The expression of phospholamban (PLB) and tumor necrosis factor-α (TNF-α) significantly increased and the expression of SERCA2a significantly decreased in PAH rats after LPS administration. LPS suppressed the RV longitudinal peak systolic strain and strain rate and cardiac function deteriorated in PAH rats. These effects may be associated with the signal pathway activity of SERCA2a/PLB.

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.

Sign in / Sign up

Export Citation Format

Share Document