The Prognostic Value of the Diastolic Stress Test in Patients Undergoing Treadmill Stress Echocardiography

2019 ◽  
Vol 32 (10) ◽  
pp. 1298-1306 ◽  
Author(s):  
Benjamin T. Fitzgerald ◽  
Jeffrey J. Presneill ◽  
Isabel G. Scalia ◽  
Casey L. Hawkins ◽  
Yael Celermajer ◽  
...  
Keyword(s):  
Prognostic Value ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Treadmill Stress

scholarly journals The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

2020 ◽  
Author(s):  
Benjamin Fitzgerald ◽  
Jelena Logan ◽  
Ashleigh Weldon ◽  
Agatha Kwon ◽  
Isabel Scalia ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Prognostic Value ◽  
Stress Echocardiography ◽  
Before And After ◽  
Treadmill Stress

Abstract 11521: Prognostic Value of Left Atrial Function in Normal Exercise Stress Echocardiography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rayji S Tsutsui ◽  
Kenya Kusunose ◽  
Zoran B Popovic ◽  
James D Thomas
Keyword(s):  
Prognostic Value ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Statistical Significance ◽  
Adverse Outcomes ◽  
Exercise Stress ◽  
Exercise Stress Echocardiography ◽  
Echocardiographic Parameters ◽  
The Mean ◽  
Artery Disease

Background: The association between poor left atrial (LA) function and adverse outcomes in subjects following an acute myocardial infarction is recognized. On the other hand, prognostic value of LA function in low risk subjects is not well characterized. The purpose of this study was to assess the prognostic value of LA function in subjects who have exercise stress echocardiography negative for ischemia. Methods: Subjects who underwent exercise stress echocardiography for exclusion of coronary artery disease (CAD) between January to April 2010 were included. Subjects were excluded if they were in atrial fibrillation/flutter at the time of exercise, left ventricular ejection fraction (LVEF) < 45%, moderate or severe valvular disease, echocardiographic evidence of exercise-induced myocardial ischemia, or had known CAD. Maximum metabolic equivalents (METs), LA total strain (analyzed offline with Siemens Syngo VVI), LV E/e’, LA volume index (LAVI) were measured for all subjects. Diagnosis of major adverse cardiac events (MACE: myocardial infarction, coronary revascularization, cardiovascular mortality) and coronary artery disease (CAD: angina, unstable angina) were recorded. Results: Of 672 subjects identified, 486 subjects remained after exclusion. The mean follow up time was 51.6 ± 1.2 months, and the mean LVEF was 56 ± 5%. Following the index stress test, 25 (5%) subjects had MACE and 35 (7%) subjects had CAD. With MACE, maximum METs was a strong prognostic factor, with worse outcome when METs < 9 (median = 9). None of the echocardiographic parameters reached statistical significance. For CAD, none of the variables reached statistical significance including METs. Conclusions: In subjects who have negative exercise stress test for ischemia, reduced METs was strongly associated with adverse outcomes. In this low risk population, none of the tested LA echocardiographic parameters appeared to be associated with adverse outcomes.

scholarly journals P207 Adjunctive application of handgrip exercise associated with rapid pacing stress echocardiography in patients with implanted pacemakers

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
P Gosciniak ◽  
T Puzik ◽  
M Leciej ◽  
E Plonska
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Prognostic Value ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Left Ventricular ◽  
Stress Echo ◽  
Pacing Mode ◽  
Rapid Pacing

Abstract The aim Assessment of safety, diagnostic, and prognostic value of a stress echocardiography protocol based on rapid pacing in patients with implanted permanent pacemakers and concomitant handgrip dynamometer method. There are no data in the literature on this type of modification of the stress test. Methods Rapid pacing stress echo tests with further handgrip were performed in 54 patients (33 females, aged 49-88, mean 72 +/- 8 years), using previously implanted permanent pacemakers. Left ventricular segmental contractility was assessed at rest, during 3 minutes pacing at the rate of 100/minutes, over 5 minutes at 85% of maximal age-predicted heart rate and then further at peak stage per 1 minute with the addition of a handgrip (compression of the dynamometer with a force equal to half the maximum strength of the patient measured before the test). The test was performed using only VVI pacing mode in 16 patients in whom atrial pacing was not possible. In the remaining 38 patients AAI/DDD pacing mode was initially used. Results No severe adverse effects were observed. Significant increase in heart rate comparing to baseline was achieved [74/minutes vs. 127/minutes (P &lt; 00001)]. Wall motion score index increased significantly (from 1.07 vs. 1.15, p &lt; 00001). During the handgrip stage, both systolic (p &lt; 0.0005) and diastolic (p &lt; 0.0001) blood pressure significantly increased. Among all surveys, 18 (33%) were considered positive, 36 (67%) negative. All the examinations were diagnostic. In 35 patients coronary angiography was performed (15 pts with test positive and 20 pts with test negative). Sensitivity, specificity, accuracy, positive, and negative predictive values for significant coronary stenosis were respectively: 61.6%, 68.2%, 65.3%, 53.3%, and 75%. For patients with DM2 the above values were: 83.3%, 85.7%, 84.6%, 83.3%, 85.7%. No statistical differences were observed depending on the type of the device or the use of beta blockers In patients with LMA stenosis test sensitivity was - 100%, with LAD – 62.5%, with CX - 75% and with RCA was 71.5%. Revasculization was required in 8 patiens with test positive and 3 with test negative (p = 0.01). During 6-moth follow-up there was no cardiac death, myocardial infarction or stroke . Conclusions The sensitivity and specificity of the stress test using the pacemaker and the handgrip method for all patients proved to be lower than the values obtained in other stress tests. However, the use of the handgrip method during stimulation caused an increase in mean systolic and diastolic blood pressure. Such an extension makes the pacing stress echo test more physiological. Moreover the stress test using pacemaker and handgrip method proved to be safe and well-tolerated by patients. The prognostic value of the negative result of the study research using stimulation from the patient"s pacemaker and the handgrip method was high in the 6 month follow-up

scholarly journals The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

2020 ◽  
Vol 37 (11) ◽  
pp. 1809-1819
Author(s):  
Benjamin T. Fitzgerald ◽  
Jelena K. Logan ◽  
Ashleigh Weldon ◽  
Agatha Kwon ◽  
Isabel G. Scalia ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Prognostic Value ◽  
Stress Echocardiography ◽  
Before And After ◽  
Treadmill Stress

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.

Inverse response of global longitudinal strain after dipyridamole stress echocardiography in patients with microvascular coronary dysfunction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Tagliamonte ◽  
C Montuori ◽  
L Riegler ◽  
A Forni ◽  
R Scarafile ◽  
...  
Keyword(s):  
Coronary Flow ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Global Longitudinal Strain ◽  
Inverse Correlation ◽  
Left Ventricular ◽  
Peak Dose ◽  
Different Response ◽  
Dipyridamole Stress Echocardiography ◽  
Dipyridamole Stress

Abstract Background Coronary microvascular dysfunction (CMD) is a potential cause of myocardial ischemia and may affect myocardial function at rest and during stress. CMD can be identified, in patients with non-obstructive coronary artery disease (CAD), by a reduced transthoracic Doppler-derived coronary flow reserve (CFR), which is an index of coronary arterial reactivity, and can be impaired in both obstructive CAD and CMD. The aim of this study was to investigate the dipyridamole-induced changes of global longitudinal strain (GLS) in patients with CMD. Methods 43 patients (29M, 14F; mean age 68±7 years) without obstructive CAD, assessed by invasive coronary angiogram, underwent dipyridamole stress echocardiography. Coronary flow was assessed in the left anterior descending coronary artery (LAD) and was identified as the colour signal directed from the base to the apex of the left ventricle, containing the characteristic biphasic pulsed-Doppler flow signals. CFR were determined as the ratio of hyperaemic to baseline diastolic coronary flow velocity. CMD was defined as CFR &lt;2. GLS was measured using automated function imaging, through the positioning of three endocardial markers (two markers at the mitral annulus and one at the apex) in each apical view. Subsequently, the obtained segmental values of GLS were visualized as a bull's-eye map in a quick and feasible manner. We had optimal left ventricular endocardial tracking in the overall population. In each patient, we used a frame rate of 70 frames/sec for adequate 2D strain analysis. We analyzed GLS at each step of stress test and compared peak-dose values with baseline. Results Thirteen patients (30%) among the overall population showed CMD. There were no significant differences in baseline characteristics between patients with or without CMD. GLS, at baseline, was significantly lower in patients with CMD (−16.9±3.78 vs. −17.8±3.77 – p&lt;0.01). We observed a different response to dipyridamole stress echocardiography, between the two groups: GLS significantly increased up to peak dose in patients without CMD (from −17.8±3.77 to −19.3±4.09 – p&lt;0.01), whereas on the other hand, a significant decrease from rest to peak dose was observed in patients with CMD (from −16.9±3.78 to −15.5±4.18 – p&lt;0.01). There was a significant inverse correlation between CFR and delta GLS measured at rest and after dipyridamole peak dose (r=−0.82 – p&lt;0.01). Conclusions GLS analysis, particularly performed by comparing dipyridamole peak-dose with baseline values, shows that in patients with CMD there is a different response of left ventricular myocardiim to stress test. It could be assumed that the inverse correlation between CFR and delta GLS reflects a progressive subclinical worsening of left ventricular myocardial function in these patients. Larger studies could confirm our data. Funding Acknowledgement Type of funding source: None

Long-term prognostic value of stress echocardiography in patients presenting to the ED with spontaneous chest pain

2014 ◽  
Vol 32 (7) ◽  
pp. 731-736 ◽  
Author(s):  
Francesca Innocenti ◽  
Prospero Cerabona ◽  
Chiara Donnini ◽  
Alberto Conti ◽  
Maurizio Zanobetti ◽  
...  
Keyword(s):  
Chest Pain ◽  
Prognostic Value ◽  
Stress Echocardiography

Abstract 16592: The Diamond-Forrester Criterion Significantly Overestimates the Risk of Obstructive Coronary Artery Disease in Patients Presenting to the Emergency Department With Low-Risk Chest Pain

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Todd Lecher ◽  
William R Davidson ◽  
Andrew Foy
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Chest Pain ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Pretest Probability ◽  
Low Risk ◽  
High Cholesterol ◽  
Observation Unit ◽  
Diamond Forrester

Introduction: We sought to (1) classify patients who underwent stress echocardiography in an emergency department observation unit based on their pretest probabilities of obstructive CAD using the Diamond-Forrester criterion, (2) to compare observed versus expected frequencies of obstructive CAD based on the Diamond-Forrester risk categories of low (<25%), intermediate (25-75%), and high (>75%) pretest probability of disease, and (3) to test the association of traditional cardiovascular risk factors (age, gender, hypertension, diabetes, high cholesterol, and smoking) with obstructive CAD. METHODS: Retrospective review of the electronic medical record for patients who presented to the emergency department with chest pain and underwent observation followed by stress echocardiography between the period January 1, 2012 to December 31, 2012. Patients were classified as low, intermediate, or high risk for obstructive CAD using the Diamond-Forrester criterion. Main outcome measures were stress echocardiography results as well as receipt of cardiac catheterization and results. RESULTS: A total of 504 patients were included in the final analysis. Overall, 4.8% had a positive stress test and only 1.2% had angiographic evidence of obstructive CAD. In each category of risk, the observed frequency of obstructive CAD was significantly lower than expected. Having a high pretest probability as defined by the Diamond-Forrester criterion was significantly associated with obstructive CAD. Age, gender, diabetes, hypertension, high cholesterol, and smoking were not independently associated with evidence of obstructive CAD; nor were any composites of these risk factors. CONCLUSIONS: The traditional Diamond-Forrester criterion significantly overestimates the probability of obstructive CAD in ED observation unit patients. Reliance on the Diamond-Forrester criterion and other traditional risk factors associated with obstructive CAD in the outpatient setting could lead to faulty Bayesian reasoning, overuse of non-invasive imaging, and improper interpretation of test results in an ED population of low-risk chest pain patients. Further work is required to determine an optimal risk-assessment strategy for this patient population.

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