Research output: Contribution to journal › Article › peer-review
Hemodynamic heterogeneity of reduced cardiac reserve unmasked by volumetric exercise echocardiography. / Stress Echo 2020 study group of the Italian Society of Cardiovascular Echography.
In: Journal of Clinical Medicine, Vol. 10, No. 13, 2906, 29.06.2021.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Hemodynamic heterogeneity of reduced cardiac reserve unmasked by volumetric exercise echocardiography
AU - Stress Echo 2020 study group of the Italian Society of Cardiovascular Echography
AU - Bombardini, Tonino
AU - Zagatina, Angela
AU - Ciampi, Quirino
AU - Arbucci, Rosina
AU - Merlo, Pablo Martin
AU - Lowenstein Haber, Diego M.
AU - Morrone, Doralisa
AU - D’andrea, Antonello
AU - Djordjevic-Dikic, Ana
AU - Beleslin, Branko
AU - Tesic, Milorad
AU - Boskovic, Nikola
AU - Giga, Vojislav
AU - de Castro e Silva Pretto, José Luis
AU - Daros, Clarissa Borguezan
AU - Amor, Miguel
AU - Mosto, Hugo
AU - Salamè, Michael
AU - Monte, Ines
AU - Citro, Rodolfo
AU - Simova, Iana
AU - Samardjieva, Martina
AU - Wierzbowska-Drabik, Karina
AU - Kasprzak, Jaroslaw D.
AU - Gaibazzi, Nicola
AU - Cortigiani, Lauro
AU - Scali, Maria Chiara
AU - Pepi, Mauro
AU - Antonini-Canterin, Francesco
AU - Torres, Marco A.R.
AU - De Nes, Michele
AU - Ostojic, Miodrag
AU - Carpeggiani, Clara
AU - Kovačević-Preradović, Tamara
AU - Lowenstein, Jorge
AU - Arruda-Olson, Adelaide M.
AU - Pellikka, Patricia A.
AU - Picano, Eugenio
N1 - Publisher Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/6/29
Y1 - 2021/6/29
N2 - Background: Two-dimensional volumetric exercise stress echocardiography (ESE) provides an integrated view of left ventricular (LV) preload reserve through end-diastolic volume (EDV) and LV contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose: To assess the dependence of cardiac reserve upon LVCR, EDV, and heart rate (HR) during ESE. Methods: We prospectively performed semi-supine bicycle or treadmill ESE in 1344 patients (age 59.8 ± 11.4 years; ejection fraction = 63 ± 8%) referred for known or suspected coronary artery disease. All patients had negative ESE by wall motion criteria. EDV and ESV were measured by biplane Simpson rule with 2-dimensional echocardiography. Cardiac index reserve was identified by peak-rest value. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values ≤2.0). Preload reserve was defined by an increase in EDV. Cardiac index was calculated as stroke volume index * HR (by EKG). HR reserve (stress/rest ratio) <1.85 identified chronotropic incompetence. Results: Of the 1344 patients, 448 were in the lowest tertile of cardiac index reserve with stress. Of them, 303 (67.6%) achieved HR reserve <1.85; 252 (56.3%) had an abnormal LVCR and 341 (76.1%) a reduction of preload reserve, with 446 patients (99.6%) showing ≥1 abnormality. At binary logistic regression analysis, reduced preload reserve (odds ratio [OR]: 5.610; 95% confidence intervals [CI]: 4.025 to 7.821), chronotropic incompetence (OR: 3.923, 95% CI: 2.915 to 5.279), and abnormal LVCR (OR: 1.579; 95% CI: 1.105 to 2.259) were independently associated with lowest tertile of cardiac index reserve at peak stress. Conclusions: Heart rate assessment and volumetric echocardiography during ESE identify the heterogeneity of hemodynamic phenotypes of impaired chronotropic, preload or LVCR underlying a reduced cardiac reserve.
AB - Background: Two-dimensional volumetric exercise stress echocardiography (ESE) provides an integrated view of left ventricular (LV) preload reserve through end-diastolic volume (EDV) and LV contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose: To assess the dependence of cardiac reserve upon LVCR, EDV, and heart rate (HR) during ESE. Methods: We prospectively performed semi-supine bicycle or treadmill ESE in 1344 patients (age 59.8 ± 11.4 years; ejection fraction = 63 ± 8%) referred for known or suspected coronary artery disease. All patients had negative ESE by wall motion criteria. EDV and ESV were measured by biplane Simpson rule with 2-dimensional echocardiography. Cardiac index reserve was identified by peak-rest value. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values ≤2.0). Preload reserve was defined by an increase in EDV. Cardiac index was calculated as stroke volume index * HR (by EKG). HR reserve (stress/rest ratio) <1.85 identified chronotropic incompetence. Results: Of the 1344 patients, 448 were in the lowest tertile of cardiac index reserve with stress. Of them, 303 (67.6%) achieved HR reserve <1.85; 252 (56.3%) had an abnormal LVCR and 341 (76.1%) a reduction of preload reserve, with 446 patients (99.6%) showing ≥1 abnormality. At binary logistic regression analysis, reduced preload reserve (odds ratio [OR]: 5.610; 95% confidence intervals [CI]: 4.025 to 7.821), chronotropic incompetence (OR: 3.923, 95% CI: 2.915 to 5.279), and abnormal LVCR (OR: 1.579; 95% CI: 1.105 to 2.259) were independently associated with lowest tertile of cardiac index reserve at peak stress. Conclusions: Heart rate assessment and volumetric echocardiography during ESE identify the heterogeneity of hemodynamic phenotypes of impaired chronotropic, preload or LVCR underlying a reduced cardiac reserve.
KW - Cardiac reserve
KW - End-diastolic volume
KW - End-systolic volume
KW - Heart rate
KW - Stress echocardiography
KW - heart rate
KW - OUTPUT
KW - end-systolic volume
KW - PRESERVED EJECTION FRACTION
KW - FAILURE
KW - stress echocardiography
KW - cardiac reserve
KW - end-diastolic volume
KW - HEART-RATE RESPONSE
KW - LEFT-VENTRICULAR FUNCTION
UR - http://www.scopus.com/inward/record.url?scp=85113730109&partnerID=8YFLogxK
U2 - 10.3390/jcm10132906
DO - 10.3390/jcm10132906
M3 - Article
AN - SCOPUS:85113730109
VL - 10
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
SN - 2077-0383
IS - 13
M1 - 2906
ER -
ID: 85561272