scholarly journals Assessment of Right Ventricular Reserve Utilizing Exercise Provocation in Systemic Sclerosis

2021 ◽  
Author(s):  
Monica Mukherjee ◽  
Valentina Mercurio ◽  
Steven Hsu ◽  
Susan A. Mayer ◽  
Stephen C Mathai ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Contractile Response ◽  
Cohort Analysis ◽  
Systolic Pressure ◽  
Peak Stress ◽  
Contractile Reserve ◽  
Systolic Strain ◽  
Main Determinant ◽  
Response To Exercise ◽  
Response Exercise

Abstract PurposeRight ventricular (RV) capacity to adapt to increased afterload is the main determinant of outcome in pulmonary hypertension (PH), a common morbidity seen in systemic sclerosis (SSc). We hypothesized that supine bicycle echocardiography (SBE), coupled with RV longitudinal systolic strain (RVLSS), improves detection of limitations in RV reserve in SSc.Methods56 SSc patients were prospectively studied during SBE with RV functional parameters compared at rest and peak stress. We further dichotomized patients based on resting RV systolic pressure (RVSP) to determine the effects of load on contractile response.ResultsOur pooled cohort analysis revealed reduced global RVLSS at rest (-16.2 ± 3.9%) with normal basal contractility (-25.6 ± 7.7%) and relative hypokinesis of the midventricular (-14.1 ± 6.0%) and apical (-8.9 ± 5.1%) segments. With exercise, global RVLSS increased significantly (p=0.0005), however despite normal basal contractility at rest, there was no further augmentation with exercise. Mid and apical RVLSS increased with exercise suggestive of RV contractile reserve. In patients with resting RVSP < 35 mmHg, global and segmental RVLSS increased with exercise. In patients with resting RVSP ≥ 35 mmHg, global and segmental RVLSS did not increase with exercise and there was evidence of exertional RV dilation.ConclusionExercise provocation in conjunction with RVLSS identified differential regional contractile response to exercise in SSc patients. We further demonstrate the effect of increased loading conditions on RV contractile response exercise. These findings suggest subclinical impairments in RV reserve in SSc that may be missed by resting noninvasive 2DE-based assessments alone.

scholarly journals Left Atrial Strain Identifies Increased Atrial Ectopy in Patients with Beta-Thalassemia Major

Diagnostics ◽  
2020 ◽  
Vol 11 (1) ◽  
pp. 1
Author(s):  
Maria Vlachou ◽  
Vasileios Kamperidis ◽  
Efthymia Vlachaki ◽  
Georgios Tziatzios ◽  
Despoina Pantelidou ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Left Atrial ◽  
Systolic Pressure ◽  
Thalassemia Major ◽  
Beta Thalassemia ◽  
Tape Recording ◽  
Blood Transfusions ◽  
Systolic Strain ◽  
Peak Systolic Strain ◽  
Beta Thalassemia Major

Patients with beta-thalassemia major (β-ΤΜ) may develop cardiac arrhythmias through a multifactorial mechanism. The current study evaluated the association of cardiac structure and function on echocardiography with atrial ectopic burden on 24-hour tape recording in β-ΤΜ patients. This prospective study included consecutive β-ΤΜ patients. Demographic, laboratory, echocardiographic, cardiac magnetic resonance (CMR) T2* and 24-hour tape recording data were prospectively collected. The patients were classified according to the median value of premature atrial contractions (PACs) on 24-hour tape. In total, 50 β-TM patients (37.6 ± 9.1 years old, 50% male) were divided in 2 groups; PACs ≤ 24/day and > 24/day. Patients with PACs > 24/day were treated with blood transfusion for a longer period of time (39.0 ± 8.6 vs. 32.0 ± 8.9 years, p < 0.007), compared to their counterparts. Older age (OR: 1.121, 95% CI: 1.032–1.217, p = 0.007), longer duration of blood transfusion (OR:1.101, 95% CI:1.019–1.188, p = 0.014), larger LV end-diastolic diameter (OR: 4.522, 95% CI:1.009–20.280, p = 0.049), higher values of LA peak systolic strain (OR: 0.869, 95% CI: 0.783–0.964, p = 0.008), higher MV E/E′ average (OR: 1.407, 95% CI: 1.028–1.926, p = 0.033) and higher right ventricular systolic pressure (OR: 1.147, 95% CI: 1.039–1.266, p = 0.006) were univariably associated with PACs > 24/day. LA peak systolic strain remained significantly associated with PACs > 24/day after adjusting for the duration of blood transfusions or for CMR T2*. The multivariable model including blood transfusion duration and LA peak systolic strain was the most closely associated with PACs > 24/day. Receiver operating characteristic curve analysis identified a left atrial peak systolic strain of 31.5%, as the best cut-off value (83% sensitivity, 68% specificity) for prediction of PACs > 24/day. In β-TM patients, LA peak systolic strain was associated with the atrial arrhythmia burden independently to the duration of blood transfusions and CMR T2*.

The effect of endogenous estrogen on Doppler-estimated right ventricular systolic pressure during exercise

2012 ◽  
Vol 90 (10) ◽  
pp. 1364-1371
Author(s):  
Vicki N. Wang ◽  
Mavra Ahmed ◽  
Amelia Ciofani ◽  
Zion Sasson ◽  
John T. Granton ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Menstrual Cycle ◽  
Right Ventricular ◽  
Systolic Pressure ◽  
Rate Pressure Product ◽  
Right Ventricular Systolic Pressure ◽  
Ventricular Systolic Pressure ◽  
Early Exercise ◽  
Endogenous Estrogen ◽  
Response To Exercise

We evaluated the effect of endogenous estrogen levels on exercise-related changes in right ventricular systolic pressure (RVSP) of healthy, eumenorrheic, sedentary women. Volunteers were studied at two separates phases of the menstrual cycle (LO and HI estrogen phases), exercised on a semi-supine ergometer with escalating workload and monitored continuously by 12-lead ECG and automated blood pressure cuff. At each exercise stage, Doppler echocardiography measurements were obtained and analyzed to determine RVSP. Fourteen subjects (age 24 ± 5) were studied. Exercise duration was significantly higher on the HI estrogen day, but no significant differences in hemodynamic response to exercise were found between the two study days. There were also no significant differences with respect to heart rate (HR) acceleration during early exercise, as well as resting and peak RVSP, HR, blood pressure, and rate pressure product. Doppler-estimated RVSP demonstrated a linear relationship to HR at a ratio of 1 mm Hg (1 mm Hg = 133.3224 Pa) for every 5 bpm (beats per minute) increase in HR. There were no differences in the slope of this relationship between HI and LO estrogen phases of the menstrual cycle. Our findings did not demonstrate any effect of endogenous estrogen levels on the modulation of the pulmonary vascular response to exercise in healthy women.

scholarly journals P329 Outcome prediction with force-based left ventricular contractile reserve during stress echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Morrone ◽  
A Zagatina ◽  
Q Ciampi ◽  
L Cortigiani ◽  
N Gaibazzi ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Hospital Admissions ◽  
Multivariable Analysis ◽  
Peak Stress ◽  
Regional Wall Motion ◽  
Left Ventricular ◽  
Contractile Reserve ◽  
Single Plane ◽  
Systolic Volume ◽  
Stress Echo

Abstract OnBehalf Stress Echo 2020 study group of the Italian Society of Cardiovascular Imaging Background Stress echo (SE) risk stratification is based on regional wall motion abnormalities (RWMA). The assessment of global left ventricular contractile reserve (LVCR) based on load-independent Force may refine prognosis. Aim To assess the value of LVCR during SE in predicting outcome Methods From September 2016 to December 2018, we prospectively enrolled 1848 patients (age 63 ± 11 years; 1121 males, 60%) with known or suspected coronary artery disease and/or heart failure evaluated with SE (exercise in 543, dipyridamole in 1184, adenosine in 10, dobutamine in 43) in 9 quality-controlled centers of 6 countries. Force was measured at rest and peak stress as the ratio of systolic blood pressure by cuff sphygmomanometer/end-systolic volume by 2D and biplane Simpson method of disks. When Simpson method was not feasible, apical single plane or linear parasternal methods were used to calculate volumes. Abnormal values of LVCR (peak/ rest) based on force were ≤1.10 for dipyridamole and adenosine; ≤1.61 for exercise or dobutamine. All patients were followed-up for a median of 16 months. Results RWMA and Force-based LVCR were obtained in all pts. Force was 4.24 ± 1.88 mmHg/ml at rest and increased during stress (7.07 ± 4.60 mmHg/ml, p&lt;.001). At individual patient analysis, LVCR was abnormal in 495 (26%) and normal in 1373 (74%) patients. At follow-up, there were 218 events: 22 deaths, 22 non-fatal myocardial infarctions, 62 hospital admissions for acute heart failures, and 112 late (&gt; 3 months from SE) myocardial revascularizations. At multivariable analysis, stress-induced RWMA (Hazard Ratio, HR, 2.899, 95% Confidence Intervals, CI: 2.032-4.137, p&lt;.0.001), force-based LVCR (HR 1.747, 95% CI: 1.245-2.470, p=.002) were independent predictors. Kaplan-Meier curves showed worse event-free survival for pts with abnormal LVCR: see figure. Conclusion LVCR based on Force is a useful adjunct to RWMA for risk stratification with SE. Abstract P329 Figure. Survival curves and LVCR

Depressed contractile response to exercise in diabetic patients in the absence of cardiovascular disease

1997 ◽  
Vol 18 (8) ◽  
pp. 761-770 ◽  
Author(s):  
H. NAGAOKA ◽  
T. IIZUKA ◽  
S. KUBOTA ◽  
N. KATO ◽  
T. SUZUKI ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Contractile Response ◽  
Diabetic Patients ◽  
Response To Exercise

Ventricular-vascular uncoupling by acute conotruncal occlusion in the stage 21 chick embryo

1997 ◽  
Vol 273 (6) ◽  
pp. H2861-H2866 ◽  
Author(s):  
Bradley B. Keller ◽  
Masaaki Yoshigi ◽  
Joseph P. Tinney
Keyword(s):  
Chick Embryo ◽  
Time Constant ◽  
Systolic Function ◽  
Systolic Pressure ◽  
Ventricular Outflow Tract ◽  
Ventricular Pressure ◽  
Contractile Reserve ◽  
Cross Sectional ◽  
Baseline Recording

Embryonic ventricular diastolic and systolic function was evaluated during normal ejection (coupled) and during acute ventricular outflow tract occlusion (uncoupled) in the stage 21 chick embryo. We simultaneously measured ventricular pressure with a servo-null system and ventricular dimensions using video microscopy. Experimental protocols included 1) baseline recording followed by acute conotruncal (CT) ligation ( n = 15) and 2) baseline recording, preload increase using Krebs-Henseleit buffer (3 μl), preload reduction via venous hemorrhage, and then CT occlusion ( n = 20). Ventricular epicardial cross-sectional area was converted to internal volume using wall volume measures and assuming an ellipsoid geometry to produce pressure-volume loops. We calculated the time constant of ventricular pressure decline using a monoexponential decay function with a pressure asymptote. As previously noted, heart rate was unaffected by acutely altered preload or afterload. CT ligation increased end-systolic pressure, maximal +dP/d t, and the time constant of ventricular pressure decline and decreased stroke volume indexed for end-diastolic volume. Thus the embryonic ventricle has significant contractile reserve masked in vivo by the dynamic coupling between the ventricle and arterial circulation.

scholarly journals Pulmonary Artery Systolic Pressure Response to Exercise in Patients with Rheumatic Mitral Stenosis: Determinants and Prognostic Value

2020 ◽  
Vol 33 (5) ◽  
pp. 550-558
Author(s):  
Sanny Cristina de Castro Faria ◽  
Henrique Silveira Costa ◽  
Judy Hung ◽  
André Gorle de Miranda Chaves ◽  
Flávio Augusto Paes de Oliveira ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Mitral Stenosis ◽  
Prognostic Value ◽  
Systolic Pressure ◽  
Pressure Response ◽  
Pulmonary Artery Systolic Pressure ◽  
Rheumatic Mitral Stenosis ◽  
Response To Exercise

scholarly journals Combination of Echocardiographic and Pulmonary Function Test Measures Improves Sensitivity for Diagnosis of Systemic Sclerosis-associated Pulmonary Arterial Hypertension: Analysis of 2 Cohorts

2013 ◽  
Vol 40 (10) ◽  
pp. 1706-1711 ◽  
Author(s):  
Heather Gladue ◽  
Virginia Steen ◽  
Yannick Allanore ◽  
Rajeev Saggar ◽  
Rajan Saggar ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Pulmonary Arterial Hypertension ◽  
Pulmonary Function ◽  
Arterial Hypertension ◽  
Pulmonary Function Test ◽  
Predictive Value ◽  
Systolic Pressure ◽  
Predictive Values ◽  
Function Test ◽  
Pulmonary Arterial

Objective.To evaluate routinely collected non-invasive tests from 2 systemic sclerosis (SSc) cohorts to determine their predictive value alone and in combination versus right heart catheterization (RHC)-confirmed pulmonary arterial hypertension (PAH).Methods.We evaluated 2 cohorts of patients who were at risk or with incident PAH: (1) The Pulmonary Hypertension Assessment and Recognition Outcomes in Scleroderma (PHAROS) cohort and (2) an inception SSc cohort at Cochin Hospital, Paris, France. Estimated right ventricular systolic pressure (eRVSP) as determined by transthoracic echocardiogram (TTE) and pulmonary function test (PFT) measures was evaluated, and the predictive values determined. We then evaluated patients with PAH missed on TTE cutoffs that were subsequently identified by a PFT measure.Results.In the PHAROS cohort (n = 206), 59 (29%) had RHC-defined PAH. An eRVSP threshold of 35–50 mm Hg failed to diagnose PAH in 7% to 31% of patients, 50% to 70% of which (n = 2–13) were captured by PFT measures. In the Cochin cohort (n = 141), 10 (7%) patients had RHC confirmed PAH. An eRVSP threshold of 35–50 mm Hg missed 0% to 70% (n = 0–7) of patients, of which 0% to 68% (n = 0–6) were met by PFT measures. The combination of TTE and PFT improved the negative predictive value for diagnosing PAH.Conclusion.In 2 large SSc cohorts, screening with TTE and PFT captured a majority of patients with PAH. TTE and PFT complement each other for the diagnosis of PAH.

scholarly journals Reduced End-Systolic Pressure-Volume Ratio Response to Exercise

2010 ◽  
Vol 3 (4) ◽  
pp. 443-449 ◽  
Author(s):  
Christine L. Jellis ◽  
Carly Jenkins ◽  
Rodel Leano ◽  
Jennifer H. Martin ◽  
Thomas H. Marwick
Keyword(s):  
Systolic Pressure ◽  
Volume Ratio ◽  
Response To Exercise ◽  
Ratio Response
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