3260Prognostic value of cardiac power reserve in patients with normal left ventricular ejection fraction undergoing exercise stress echocardiography

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Anand ◽  
G Kane ◽  
S Pislaru ◽  
R Adigun ◽  
R McCully ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Ejection Fraction ◽  
Power Output ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Cardiac Power ◽  
Lv Mass

Abstract Background Cardiac power output-to-mass (CPOM) ratio is a measure of myocardial performance that incorporates both pressure and flow output, normalized to left ventricular (LV) mass generating that cardiac work. Prior small studies have shown that CPOM predicts outcomes in patients with ischemic cardiomyopathy and reduced LV ejection fraction (EF). We sought to evaluate the prognostic significance of peak exercise CPOM and power reserve (increase from rest to peak exercise) in patients with normal EF. Methods and results Retrospective study in 24,783 patients (age 59±13 years, 45% females) with EF≥50% and no significant valve disease or right ventricular (RV) dysfunction, undergoing exercise stress echocardiography between 2004–2018. CPOM was calculated as previously described (0.222 x cardiac output x mean blood pressure / LV mass) and expressed in Watts/100g myocardium. Power reserve was calculated as difference in CPOM between peak stress and rest. All-cause mortality was the primary endpoint. Patients were divided into quartiles of power reserve. Patients with higher power reserve were younger, had higher blood pressure and heart rate, lower LV mass, and lower prevalence of prior myocardial infarction. (Table). During follow-up (median (IQR) 3.9 (0.6–8.3) years), 931 (3.8%) patients died. Progressively lower power reserve was associated with increasing mortality (Figure A). Compared to patients with abnormal stress test, patients with the lowest power reserve but otherwise normal stress test had the same survival as those with infarction/cardiomyopathy or ischemia on stress test (Figure B). Resting CPOM had lower predictive value. After adjusting for age, sex, METs achieved, ischemia/infarction on stress test results, and diastolic function grade, both peak exercise CPOM and power reserve were independent predictors of mortality (p<0.0001), incremental to conventional measures. Conclusion Cardiac power output and reserve measured during exercise stress echo provides independent prognostic information in patients with normal resting EF and no significant valve disease or RV dysfunction. The survival of patients with low power reserve but normal stress test was similar to patients with prior infarction/ cardiomyopathy or ischemia on stress test.

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 &lt; 0.001] and HF at follow-up [adjusted HR, highest vs. lowest quartile, 0.4, 95% CI (0.3, 0.5), P &lt; 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 Sacubitril/Valsartan Improves Autonomic Function and Cardiopulmonary Parameters in Patients with Heart Failure with Reduced Ejection Fraction

2020 ◽  
Vol 9 (6) ◽  
pp. 1897 ◽  
Author(s):  
Francesco Giallauria ◽  
Giuseppe Vitale ◽  
Mario Pacileo ◽  
Anna Di Lorenzo ◽  
Alessandro Oliviero ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Autonomic Function ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Left Ventricular Ejection ◽  
Peak Exercise ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction

Background: Heart rate recovery (HRR) is a marker of vagal tone, which is a powerful predictor of mortality in patients with cardiovascular disease. Sacubitril/valsartan (S/V) is a treatment for heart failure with reduced ejection fraction (HFrEF), which impressively impacts cardiovascular outcome. This study aims at evaluating the effects of S/V on HRR and its correlation with cardiopulmonary indexes in HFrEF patients. Methods: Patients with HFrEF admitted to outpatients’ services were screened out for study inclusion. S/V was administered according to guidelines. Up-titration was performed every 4 weeks when tolerated. All patients underwent laboratory measurements, Doppler-echocardiography, and cardiopulmonary exercise stress testing (CPET) at baseline and at 12-month follow-up. Results: Study population consisted of 134 HFrEF patients (87% male, mean age 57.9 ± 9.6 years). At 12-month follow-up, significant improvement in left ventricular ejection fraction (from 28% ± 5.8% to 31.8% ± 7.3%, p < 0.0001), peak exercise oxygen consumption (VO2peak) (from 15.3 ± 3.7 to 17.8 ± 4.2 mL/kg/min, p < 0.0001), the slope of increase in ventilation over carbon dioxide output (VE/VCO2 slope )(from 33.4 ± 6.2 to 30.3 ± 6.5, p < 0.0001), and HRR (from 11.4 ± 9.5 to 17.4 ± 15.1 bpm, p = 0.004) was observed. Changes in HRR were significantly correlated to changes in VE/VCO2slope (r = −0.330; p = 0.003). After adjusting for potential confounding factors, multivariate analysis showed that changes in HRR were significantly associated to changes in VE/VCO2slope (Beta (B) = −0.975, standard error (SE) = 0.364, standardized Beta coefficient (Bstd) = −0.304, p = 0.009). S/V showed significant reduction in exercise oscillatory ventilation (EOV) detection at CPET (28 EOV detected at baseline CPET vs. 9 EOV detected at 12-month follow-up, p < 0.001). HRR at baseline CPET was a significant predictor of EOV at 12-month follow-up (B = −2.065, SE = 0.354, p < 0.001). Conclusions: In HFrEF patients, S/V therapy improves autonomic function, functional capacity, and ventilation. Whether these findings might translate into beneficial effects on prognosis and outcome remains to be elucidated.

scholarly journals Effects of Atorvastatin on Resting and Peak Exercise Blood Pressure among Normotensive Men and Women

Cholesterol ◽  
2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Amanda L. Zaleski ◽  
Marianne L. Mentch ◽  
Linda S. Pescatello ◽  
Beth A. Taylor ◽  
Jeffrey A. Capizzi ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Stress Test ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Exercise Stress Test ◽  
Total Sample ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Exercise Blood Pressure ◽  
Double Blinded

Statins are the most widely prescribed and effective medication for reducing low density lipoprotein cholesterol. Statins may also lower resting blood pressure (BP); however, results are inconsistent. We sought to determine if the maximum dose of atorvastatin reduces resting BP and the peak systolic BP (SBP) achieved on a graded exercise stress test (GEST) among a large sample of 419 healthy men (48%) and women (52%). Subjects (419, 44.1±0.8 yr) were double-blinded and randomized to 80 mg·d−1 of atorvastatin (n=202) or placebo (n=217) for 6 mo. Among the total sample, there were no differences in resting BP (SBP, P=0.30; diastolic BP [DBP], P=0.69; mean arterial pressure (P=0.76); or peak SBP on a GEST (P=0.99)) over 6 mo, regardless of drug treatment group. However, among women on atorvastatin, resting SBP/DBP (3.7±1.5 mmHg, P=0.01/3.2±0.9 mmHg, P=0.02) and peak SBP on a GEST (6.5±1.5 mmHg, P=0.04) were lower versus men. Atorvastatin lowered resting BP 3-4 mmHg and peak SBP on a GEST ~7 mmHg more among women than men over 6 mo of treatment. The inconsistent findings regarding the antihypertensive effects of statins may be partially explained by not accounting for sex effects.

Elevated Blood Pressure in a High School Football Player: Case Presentation and Discussion

1990 ◽  
Vol 2 (4) ◽  
pp. 384-394
Author(s):  
Ted A Kaplan
Keyword(s):  
High School ◽  
Blood Pressure ◽  
Cardiovascular Response ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Football Player ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Elevated Systolic Blood Pressure ◽  
Graded Exercise

A case is presented of an adolescent high school athlete found to have mildly elevated systolic blood pressure (BP) at the preseason group physical examination. As part of the evaluation to clear him for participation, a graded exercise stress test was performed. The test revealed a systolic BP at peak exercise of 260 mm Hg. The rationale for hygienic and pharmacologic management of this situation is discussed, and the results of this process are detailed. This patient was finally treated with nifedipine after unacceptable results with lisinopril, pindolol, and nonpharmacological approaches. The graded exercise test can be a valuable part of the evaluation of a hypertensive athlete. Besides revealing the occasional dangerous superelevation of BP, the test results can reveal the individual’s cardiovascular response to stress. This can provide insight into the etiology of and prognosis for the patient’s problem. Follow-up testing should be done after any treatment is provided.

scholarly journals Coagulation and inhibitory and fibrinolytic proteins in essential hypertension.

1993 ◽  
Vol 4 (2) ◽  
pp. 222-228
Author(s):  
N D Vaziri ◽  
D H Smith ◽  
R L Winer ◽  
M A Weber ◽  
E C Gonzales ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Blood Coagulation ◽  
Plasminogen Activator ◽  
Stress Test ◽  
Exercise Stress Test ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Tissue Plasminogen ◽  
D Dimer

Arterial hypertension (HTN) increases the risk of cerebral coronary, and other vascular complications that frequently involve platelet activation and blood coagulation. Several key proteins in the blood coagulation, fibrinolytic and inhibitory systems were studied in 29 men with HTN (aged 45 +/- 3 yr) and 15 normal men of the same age. Plasma levels of high-molecular-weight kininogen and factors XII, IX, VII, X, II, and XIII, as well as von Willebrand factor (vWF), fibrinogen, fibronectin, alpha 2-antiplasmin, tissue-plasminogen activator, D-dimer, platelet factor-4, and protein C were measured by the use of appropriate functional and immunologic assays before and after a cardiopulmonary exercise stress test. The concentrations of vWF, alpha 2-antiplasmin, and D-dimer were significantly (P < 0.02) higher in the HTN group as compared with the control group. The exercise stress test resulted in significant rises in the plasma vWF, alpha 2-antiplasmin, and tissue-plasminogen activator levels in the two groups. The concentrations of vWF and D-dimer were related to diastolic blood pressure (r = 0.44 and 0.40, respectively; P < 0.02). Levels of vWF also were related to left ventricular mass index and left ventricular posterior wall and septal thickness (r = 0.34, 0.43, and 0.34, respectively; P < 0.05). The constellation of these findings suggests a low-grade fibrin formation and degradation, the magnitude of which is related to the diastolic blood pressure. The observed abnormalities can potentially contribute to the cardiovascular complications of untreated HTN.

scholarly journals Myocardial Work and Left Ventricular Contractile Reserve During Stress Echocardiography: An Angiographic Validation

2021 ◽  
Author(s):  
Natalie Edwards ◽  
Gregory Scalia ◽  
Anthony Putrino ◽  
Vinesh Appadurai ◽  
Surendran Sabapathy ◽  
...  
Keyword(s):  
Stress Echocardiography ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Exercise Stress ◽  
Peak Exercise ◽  
Contractile Reserve ◽  
Surgical Revascularisation ◽  
Constructive Work ◽  
Global Work ◽  
Exercise Induced

Objective This study sought to determine the contractile reserve (CR) response to exercise stress echocardiography (ESE) quantified by the novel parameter, non-invasive myocardial work (MW), in subjects with angiographically proven coronary artery disease (CAD). Methods CR was measured by the relative change in ejection fraction (EF), global longitudinal strain (GLS) and MW indices from rest to peak exercise in 304 patients referred for clinically indicated ESE. Positive ESE patients proceeded to coronary angiography and further risk stratified based on either percutaneous or surgical intervention. Results CR and global work index (CR) significantly decreased with exercise induced ischaemia and angiographically proven significant CAD (CR -1.6±3.5%; CR -8.6±511mmHg% decrement, p<0.001) compared to non-ischaemic patients (CR 1.4±2.2%; CR 398±404mmHg% improvement). Global constructive work (CR) was significantly higher (p<0.0001) in non-ischaemic (818±457mmHg%) and blunted in ischaemic patients (208±550mmHg%). CR (AUC 0.81; 95%CI 0.74-0.88) was superior to CR (AUC 0.75; 95%CI:0.67-0.83), CR (AUC 0.73, 95%CI:0.64-0.82) and CR (AUC 0.71; 95%CI:0.62-0.81, p<0.001) to detect inducible ischaemia. Subgroup analysis showed patients requiring surgical revascularisation demonstrated a significantly lower CR (-11.5±7.6%, p<0.05) as a result of reduced CR (281±573mmHg%, p<0.05) and increased global wasted work (CR, 289±151mmHg%, p=0.09). Conclusion Multivessel disease requiring surgical revascularisation have the greatest reduction in CR. MW may potentially improve detection of ischaemia and further risk stratification during ESE to maximise the benefits of revascularisation.

scholarly journals The Relationship between Left Ventricular Function Indices in Tissue Doppler Imaging and Exaggerated Blood Pressure Response During the Exercise Stress Test

2020 ◽  
Vol 9 ◽  
pp. 1323
Author(s):  
Milad Hemati ◽  
Arash Gholoobi ◽  
Ali Eshraghi ◽  
Javad Sadeghi Allah Abadi ◽  
Fereshteh Ghaderi
Keyword(s):  
Blood Pressure ◽  
Tissue Doppler Imaging ◽  
Exercise Test ◽  
Blood Pressure Response ◽  
Stress Test ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Pressure Response ◽  
Doppler Imaging ◽  
Lv Mass

Background: Studies have indicated that exaggerated hypertension during activity and stress can be a good predictor of the incidence of hypertension. This study tries to evaluate left ventricular (LV) function by tissue Doppler to assess early changes in ventricular compliance before the onset of Hypertension (HTN) in patients with exaggerated blood pressure response during the exercise test. Materials and Methods: In this case-control study, 40 patients without a history of hypertension with systolic blood pressure less than 140/90 which referred for exercise test, were included. The exercise test was performed for all patients. Patients who had exaggerated blood pressure during the stress test were considered as cases and the controls with normal blood pressure responses. Then standard echocardiography and Tissue Doppler imaging performed and indices of LV systolic and diastolic were recorded. Results: The LV mass in cases and controls were 174.9±50.78 and 152.9±33.59, respectively (P=0.114), and LV mass index in cases and controls were 127.4±13.5 and 79.8±15.75, respectively (P=0.023). Moreover, the LV Myocardial Performance Index were 0.68±0.11 and 0.48±0.06 in cases and controls, respectively (P<0.001). The heart rate, E/A, EE, E Velocity and S velocity were measuremented. Except E/A (P=0.009), there was no significant difference between the other variables measured between the cases and controls (P>0.05). Conclusion: The results of this study showed that using 2D conventional echocardiography as a noninvasive method if performed in prestigious centers can evaluate systolic and diastolic function Tissue Doppler parameters very well in the early stages of heart disease caused by HTN. [GMJ.2020;9:e1323]

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