P4986Quadruple imaging exercise stress echocardiography in unexplained dyspnoea

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Zagatina ◽  
Q Ciampi ◽  
N Zhuravskaya ◽  
C Carpeggiani ◽  
E Picano
Keyword(s):  
Flow Velocity ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Significant Coronary Artery Disease ◽  
Exercise Stress ◽  
Initial Population ◽  
Imaging Protocol ◽  
Exercise Stress Echocardiography ◽  
B Lines ◽  
Positivity Criterion

Abstract Background Current guidelines recommend the use of exercise stress echocardiography (ESE) in patients with unexplained dyspnoea. The methodological standard of ESE was recently reshaped with the quadruple imaging protocol, mainly tested in patients with chest pain. Aim of this study was to define the ESE pattern of response in patients with dyspnoea as the main symptom Methods From the initial population on a 1-year cohort of 604 patients referred in a single center for clinically-driven semi-supine ESE, we selected a subset of 93 consecutive patients (age 63±9 years, 52 females, resting Ejection fraction = 64±7%) with exertional dyspnea (shortness of breath, exertional fatigue or poor exercise capacity). All underwent quadruple imaging ESE: 1- Regional wall motion abnormalities (RWMA, step A) assessment (with wall motion score index, WMSI); 2- B-lines (step B) with simplified 4-site scan, each space scored from 0 = black, to 10= white (positivity criterion: stress score > rest for at least 2 points); 3- Left ventricle contractile reserve (LVCR, step C) assessment with stress/rest ratio of LV force measured as systolic blood pressure/end-systolic volume (positivity criterion:<2.0); 4- Pulsed-wave Doppler coronary flow velocity reserve (CFVR, step D) assessment in mid-distal LAD (positivity criterion: stress/rest diastolic peak flow velocity <2.0). Readers were accredited for each parameter upstream to recruitment via a web-based system. Results Feasibility was 100% for steps A, B and C, and 82% for step D. RWMA were present in 56 patients (60%). Of them, 27 underwent coronary angiography verification, showing significant coronary artery disease in 81%. B-lines positivity occurred in 35 patients (38%), an abnormal LVCR in 63 patients (68%), and a reduced CFVR in 44 pts (55%). At least one positivity criterion was observed in 80 patients (86%). Conclusions Patients with unexplained dyspnea are a reason of referral to ESE, accounting for 15% of contemporary testing. Quadruple imaging is useful to document the origin of dyspnoea as an ischemic equivalent (A positivity) and/or its cardiogenic origin for acute backward failure with pulmonary congestion (B positivity), myocardial function abnormalities (C positivity), and reduction of CFVR of microvascular-epicardial-myocardial origin (D positivity). Dyspnoea of unexplained origin is a multifactorial problem, and a more comprehensive assessment of these patients during ESE expands the clinical potential of the method.

scholarly journals Pulmonary congestion during exercise stress echocardiography in ischaemic, heart failure and valvular patients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Merli ◽  
A Zagatina ◽  
P.M Merlo ◽  
R Arbucci ◽  
C Borguezan Daros ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Ejection Fraction ◽  
Valvular Heart Disease ◽  
Healthy Subjects ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Pulmonary Congestion ◽  
Exercise Stress Echocardiography ◽  
B Lines

Abstract Background Lung ultrasound (LUS) detects pulmonary congestion as B-lines at rest and exercise stress echocardiography (ESE). Aim To assess the prevalence of B-lines during ESE in different cardiovascular diseases. Methods We performed ESE plus LUS (4-site simplified scan) in 4419 subjects referred for semi-supine bike ESE in 28 certified centers. B-lines score ranged from 0 (normal) to 40 (severely abnormal). Stress B-lines abnormal result was ≥2 units. Six different populations were evaluated: healthy controls (n=103); chronic coronary syndromes (CCS, n=3701); heart failure with reduced ejection fraction (HFrEF, n=395); heart failure with preserved ejection fraction (HFpEF, n=70); valvular heart disease (VHD) for ischemic mitral regurgitation ≥moderate at rest (n=123); repaired tetralogy of Fallot (ToF, n=27). Results Feasibility of B-lines was 100% at rest and peak ESE in all subjects. Imaging and analysis time were &lt;1 minute. B-lines (median) were not detectable in healthy subjects (rest=0.1 [0–1] vs 0.1 [0–1], p=ns) and TOF (rest=0.2 [0–2] vs 0.3 [0–4], p=ns), but were present in all other groups: see figure. During ESE, B-lines increased in CCS (rest=0.5 [0–24] vs ESE=1.3 [0–28], p&lt;0.001); HFrEF (rest=1.4 [0–35] vs ESE=2.9 [0–40], p&lt;0.001); HFpEF (rest=0.3 [0–2] vs ESE=3.4 [0–12], p&lt;0.001), VHD (rest=1.7 [0–12] vs ESE=4.3 [0–23], p&lt;0.001). Stress B-lines were correlated with stress-rest change in wall motion score index in CCS (r=0.325, p&lt;0.001), contractile reserve in HFrEF (r=−0.266, p&lt;0.001) and in VHD (r=−.0300, p=0.001), left atrial volume stress-rest change in HFpEF (r=0.287, p=0.043). Conclusion B-lines identify the pulmonary congestion phenotype at rest and more frequently during ESE in patients with different coronary, myocardial or valvular heart disease, all sharing the final common pathway of acute backward left heart failure through different disease-specific mechanisms. B-lines are absent in healthy subjects and in conditions inducing a mostly right-sided overload such as repaired ToF. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. B-lines at rest and during stress. Percentage (%) of rest (empty bar) and stress (full bar) B-lines abnormality (≥2 units) in six different study groups.

scholarly journals Frequency and characteristics of myocardial ischemia recorded during stress echocardiography in patients with high coronary risk

2011 ◽  
Vol 68 (5) ◽  
pp. 393-398 ◽  
Author(s):  
Stevan Ilic ◽  
Marina Deljanin-Ilic ◽  
Viktor Stoickov
Keyword(s):  
Myocardial Ischemia ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Exercise Stress ◽  
Silent Myocardial Ischemia ◽  
Coronary Risk ◽  
Wall Motion Score Index ◽  
Exercise Stress Echocardiography ◽  
Asymptomatic Subjects ◽  
Score Index

Background/Aim. Ischemic heart disease is the major cause of morbidity and mortality in the world as well as in our country. Ischemic heart disease has the multifactorial origin and the presence of several risk factors increases the risk of myocardial ischemia. The aim of the study was to evaluate the frequency and characteristics of myocardial ischemia in asymptomatic subjects with two or more risk factors for coronary artery disease during stress echocardiography. Methods. In 240 high risk asymptomatic subjects (an absolute risk of fatal cardiovascular disease of more than 5%, according to the Systemic Coronary Risk Evaluation Chart), the exercise stress echocardiography test was performed. The criterion for myocardial ischemia was the appearance of transient segmental wall motion abnormality (WMA). The wall motion score index was calculated before and after the exercise stress echocardiography. Results. During exercise stress echocardiography, in 36 (15%) subjects WMA occurred. Out of 36 subjects with myocardial ischemia, in 10 (27.8%) subjects WMA and ST segment depression were accompanied with the first occurrence of chest pain (the subgroup with symptomatic myocardial ischemia), in 20 (55.6%) subjects WMA and ST segment depression were detected and in 6 (16.6%) subjects only WMA occurred (the subgroup with silent myocardial ischemia). There were no significant differences between the subgroups with symptomatic and silent myocardial ischemia with regard to exercise tolerance, heart rate at the onset of WMA, and time to the onset of WMA, but the wall motion score index was significantly higher in the subjects with symptomatic myocardial ischemia (p < 0.01). In all the individuals with symptomatic myocardial ischemia, significant stenosis of the coronary arteries was found by coronary angiography. Out of 26 subjects with asymptomatic myocardial ischemia, coronary angiography was performed in 18 and significant stenosis of the coronary arteries was diagnosed in all of them. The number and grade of coronary stenosis in subjects with symptomatic and silent myocardial ischemia were similar. Conclusion. The obtained results presented the incidence of myocardial ischemia in 15% of asymptomatic subjects with high coronary risk during stress echocardiography. Silent myocardial ischemia was markedly more frequent than symptomatic one, but in the subjects with symptomatic ischemia, the wall motion score index was significantly higher.

P1504Impact of myocardial ischemia induced by exercise stress echocardiography on the QT dispersion in patients with the left bundle branch block

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Stoickov ◽  
M Deljanin Ilic ◽  
I Tasic ◽  
L J Nikolic ◽  
D Marinkovic ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Left Bundle Branch Block ◽  
Wall Motion Abnormality ◽  
Stress Echocardiography ◽  
Wall Motion ◽  
Qt Dispersion ◽  
Exercise Stress ◽  
Bundle Branch Block ◽  
Exercise Stress Echocardiography ◽  
The Impact

Abstract Background/Introduction ECG has always provided very useful information that can be used to diagnosis, treatment and prevention of cardiovascular events, but ECG changes is not useful to the detection of myocardial ischemia in patients with left bundle branch block (LBBB). QT dispersion (QTd) is a measure of inhomogeneous repolarization of myocardium. Abnormally high QTd has been correlated with risk of cardiac death in coronary patients. Purpose The aim of this study was to establish the impact of myocardial ischemia induced by exercise stress echocardiography on the QT dispersion in patients with the left bundle branch block. Methods The study involved 123 patients with LBBB, average age 52.7 years. In all subjects clinical examination, standard ECG and exercise stress echocardiography, were performed. The criterion for myocardial ischemia was the appearance of transient segmental wall motion abnormality. The first ECG was done before the exercise stress echocardiography and the second one was done immediately after exercise, with calculation of corrected QT dispersion (QTdc). Results During exercise stress echocardiography, in 45 (36.6%) subjects wall motion abnormality occurred (group with myocardial ischemia: MI), and 78 (63.4%) subjects were without ischemia (group without myocardial ischemia: NMI). Before starting the exercise stress echocardiography, MI group patients had significantly higher values of QTdc (61.2±17.6 vs 43.6±15.4 ms; p<0.001) in comparison to NMI group patients. During the exercise stress echocardiography, the QTdc significantly increased in MI group from 61.2±17.6 to 87.4±20.3 ms (p<0.001). In the NMI group there were no significant changes in the values QTdc during exercise stress echocardiography (from 43.6±15.4 to 46.5±19.8 ms (p - NS). Conclusions Significant increase of QT dispersion is associated with the occurrence of myocardial ischemia during exercise stress echocardiography in patients with LBBB. This new diagnostic approach, of using QT dispersion, significantly improves the clinical usefulness of exercise stress echocardiography in detecting myocardial ischemia in patients with LBBB.

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 Echocardiographic markers of inducible myocardial ischemia at baseline evaluation preparatory to exercise stress echocardiography

2015 ◽  
Vol 14 (1) ◽  
Author(s):  
Antonella Cherubini ◽  
Giovanni Cioffi ◽  
Carmine Mazzone ◽  
Giorgio Faganello ◽  
Giulia Barbati ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Exercise Stress Echocardiography ◽  
Baseline Evaluation
Sign in / Sign up

Export Citation Format

Share Document