Influence of impaired right ventricular contractile reserve on exercise capacity in patients with precapillary pulmonary hypertension: A study with exercise stress echocardiography

2019 ◽  
Vol 36 (4) ◽  
pp. 671-677
Author(s):  
Di‐Chen Guo ◽  
Yi‐Dan Li ◽  
Yuan‐Hua Yang ◽  
Wei‐Wei Zhu ◽  
Lan‐Lan Sun ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Exercise Capacity ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Contractile Reserve ◽  
Exercise Stress Echocardiography

scholarly journals Evaluation of right ventricular contractile reserve with exercise stress echocardiography

2019 ◽  
Vol 11 (3) ◽  
pp. e325-e326
Author(s):  
A. Missana ◽  
M. Azzolini-Jacquin ◽  
C. David ◽  
D. Baudouy ◽  
B. Sartre ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Contractile Reserve ◽  
Exercise Stress Echocardiography

scholarly journals P941 Evaluation of right ventricular contractile reserve with exercise stress echocardiography

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Missana ◽  
M Azzolini Jacquin ◽  
C David ◽  
D Baudouy ◽  
B Sartre ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Control Group ◽  
Contractile Reserve ◽  
Peak Strain ◽  
Systolic Strain ◽  
Peak Systolic Strain ◽  
Exercise Stress Echocardiography ◽  
Rv Function

Abstract INTRODUCTION Right ventricular (RV) contractile reserve reflects the ability of the RV to adapt to elevated afterload. RV functional response to exercise is challenging but could represent an important prognostic factor, especially in pulmonary arterial hypertension (PAH) patients. We aimed, using exercise stress echocardiography (ESE), to assess different RV contractile reserve evaluation methods in a cohort of PAH patients and controls. METHODS We prospectively included 12 patients with PAH and 12 healthy volunteers. An ESE (using tilt-table ergometer) was performed in all patients to assess RV function at rest and under peak exercise. Changes in these parameters during exercise were calculated to quantify the RV contractile reserve. 3D RV function as well as peak systolic strain, pulmonary pressures, TAPSE, pulmonary TVI and pulmonary output (using the right ventricular outflow tract diameter) were assessed in all patients. RESULTS Our patient group was composed by PAH patients, 61.5 ± 14.8 years; mean age of our control group was 29.33 ± 5.5 years. PAH patients achieved an exercise with a mean workload of 69.17 ± 26.4 Watts. There was no complication after the exercise test in all patients. Change in TAPSE was not significantly different between patients and controls (p = 0.17), whereas change in pulmonary TVI, pulmonary output and RV peak systolic strain was highly discriminant (respectively p = 0.03, p = 0.009 and p = 0.0009). Regarding RV contractile reserve parameters, RV end-systolic pressure area ratio (peak/rest) was not statistically different between controls and patients (p = 0.14) whereas change in TAPSE/sPAP, RV peak strain/sPAP, 3D RV EF/sPAP were significantly different (p = 0.005, p= 0.0008, p = 0004). CONCLUSION Changes in pulmonary output, RV peak systolic strain as well as changes in TAPSE/sPAP but mainly RV peak strain/sPAP, 3D RV EF/sPAP represent consistent and feasible tools to assess RV contractile reserve. echocardiographic parameters PAH (n = 12) Healthy Controls (n = 12) p value sPAP at rest (mmHg) 40.91 ± 10.7 15.42 ± 4.1 <0.001 sPAP at peak (mmHg) 82.50 ± 21.7 42.50 ± 17.8 <0.001 TAPSE at rest/sPAP at rest (mm/mmHg) 0.62 ± 0.2 1.72 ± 0.6 <0.001 TAPSE at peak /sPAP at peak 0.36 ± 0.1 0.80 ± 0.2 <0.001 ΔStrain (%) 3.43 ± 3.1 8.08 ± 2.8 <0.001 Δ(peak Strain/sPAP) -0.17 ± 0.2 -0.77 ± 0.4 <0.001 Δpulmonary TVI (cm) 3.88 ± 4.0 7.46 ± 3.5 0.03 Δ(RVEF/sPAP) -0.34 ± 0.4 -2.06 ± 1.7 <0.001 Abstract P941 Figure. echography (rest/peak) PAH patient

scholarly journals Evaluation of right ventricular contractile reserve with exercise stress echocardiography

2020 ◽  
Vol 12 (1) ◽  
pp. 69
Author(s):  
A. Missana ◽  
M. Azzolini-Jacquin ◽  
C. David ◽  
D. Baudouy ◽  
B. Sartre ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Contractile Reserve ◽  
Exercise Stress Echocardiography

scholarly journals Pulmonary hypertension subjects exhibit right ventricular transient exertional dilation during supine exercise stress echocardiography

2019 ◽  
Vol 9 (2) ◽  
pp. 204589401985190 ◽  
Author(s):  
Rama El-Yafawi ◽  
David Rancourt ◽  
Melkon Hacobian ◽  
Dennis Atherton ◽  
Mylan C. Cohen ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Healthy Controls ◽  
Ventricular Size ◽  
Basal Diameter ◽  
Exercise Stress Echocardiography ◽  
Right Ventricular Size ◽  
Longitudinal Diameter

Pulmonary hypertension is a condition with high morbidity and mortality. Resting transthoracic echocardiography is a pivotal diagnostic and screening test for pulmonary hypertension. The role of exercise stress echocardiography in the diagnosis of pulmonary hypertension is not well-established. We studied right ventricular size changes during exercise using exercise stress echocardiography to assess differences between normal and pulmonary hypertension patients and evaluate test safety, feasibility, and reproducibility. Healthy control and pulmonary hypertension patients performed recumbent exercise using a bicycle ergometer. Experienced echocardiography sonographers recorded the following resting and peak exercise right ventricular parameters using the apical four chamber view: end-diastolic area; end-systolic area; mid-diameter; basal diameter; and longitudinal diameter. Two cardiologists masked to clinical information subsequently analyzed the recordings. Parameters with acceptable inter-rater reliability were analyzed for statistical differences between the normal and pulmonary hypertension patient groups and their association with pulmonary hypertension. We enrolled 38 healthy controls and 40 pulmonary hypertension patients. Exercise stress echocardiography testing was found to be safe and feasible. Right ventricular size parameters were all readily obtainable and all had acceptable inter-observer reliability except for right ventricular longitudinal diameter. During exercise, healthy controls demonstrated a decrease in right ventricular end-systolic area, end-diastolic area, mid-diameter, and basal diameter ( P < 0.05). Conversely, pulmonary hypertension patients demonstrated an increase in right ventricular end-systolic area, end-diastolic area, and mid-diameter ( P < 0.05). These changes were unaffected by multivariate corrections. The sensitivity for pulmonary hypertension of an increase in right ventricular size was 97.2% with a negative predictive value of 95.2%. The ROC C-statistic for increase in right ventricular size was 0.93. This transient exertional dilation (TED) of the right ventricle is observed in pulmonary hypertension patients but not in healthy controls. Recumbent right ventricular exercise stress echocardiography is a feasible and safe diagnostic test for pulmonary hypertension which warrants additional study.

Impact of right ventricular contractile reserve on exercise capacity in patients with heart failure: clinical application of low-load exercise stress echocardiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Kinoshita ◽  
K Inoue ◽  
Y Akazawa ◽  
H Nakagawa ◽  
Y Sasaki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Exercise Capacity ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Contractile Reserve ◽  
Peak Vo2 ◽  
Patients With Heart Failure ◽  
Low Load ◽  
Rv Function

Abstract Background The peak oxygen uptake (VO2) evaluated by the cardiopulmonary exercise test (CPX) is an established marker of exercise capacity in patients with heart failure (HF). In particular, peak VO2 &lt;14 ml/kg/min is used to be one of the criteria for heart transplantation. However, given exercise intolerance in patients with HF, it is difficult for refractory HF patients to reach sufficient exercise load. A recent report has highlighted significant impact of right ventricular (RV) function on mortality and urgent heart transplantation. Taken together, we hypothesized that the assessment of RV function was helpful to predict exercise capacity by using low-load exercise stress echocardiography (low-load ESE) in patients with HF. Purpose We evaluated whether RV dysfunction assessed by the low-load ESE determined a low peak VO2 &lt;14 ml/kg/min in patients with HF. Methods We studied 67 consecutive hospitalized patients with HF (mean age, 65 years; 75% male; mean LV ejection fraction, 36%) who underwent ESE and CPX after stabilized HF condition, and the time interval of CPX and ESE tests was within 48 hours. CPX was performed using an upright cycle ergometer by a ramp protocol, while ESE was performed using ergometer in semi-supine position and the workload was generally increased by 25 watts every 3 minutes. The low-load ESE was defined as the 25 watts exercise. The increments of RV s' velocity at tricuspid annulus and RV strain in the free wall were considered as a preservation of RV contractile reserve. Among the study population, 26 patients were performed right heart catheterization and RV dP/dt/Pmax was estimated as an invasive marker of RV contractility. Results The achieved intensity of exercise was 50.4±21.0 watts, and all patients completed the low-load ESE. The invasive study showed that the change of RV s' velocity during the low-load ESE significantly correlated with RV dP/dt/Pmax (r=0.706, p&lt;0.001). As shown in Figure, the non-invasive parameters of RV contractile reserve during the low-load ESE were significantly correlated with peak VO2 (RV s' velocity: r=0.787, p&lt;0.001; RV strain: r=0.244, p=0.047). ROC analysis showed that the change of RV s' velocity during the low-load ESE correctly identified patients with peak VO2 &lt;14 ml/kg/min (AUC=0.95, sensitivity 92.3%, specificity 85.2%). In terms of inter- and intra-observer variabilities, ICCs of the change of RV s' velocity were 0.86 and 0.96, and ICCs of the changes of RV strain were 0.63 and 0.70, respectively. Conclusion The change of RV s' velocity during the low-load ESE could determine exercise tolerance in patients with HF. The assessment of RV contractile reserve might be clinically useful to discriminate high risk HF patients. Figure 1 Funding Acknowledgement Type of funding source: None

PREVALENCE AND SIGNIFICANCE OF RESTING PULMONARY HYPERTENSION IN PATIENTS REFERRED FOR EXERCISE STRESS ECHOCARDIOGRAPHY

CHEST Journal ◽  
2008 ◽  
Vol 134 (4) ◽  
pp. 135P
Author(s):  
Garvan C. Kane ◽  
Naser M. Ammash ◽  
Jae K. Oh ◽  
Thomas Behrenbeck ◽  
Patricia A. Pellikka ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Stress Echocardiography ◽  
Exercise Stress ◽  
Exercise Stress Echocardiography

The Clinical Significance and advantages of Stress Echocardiography in patients with moderate to severe aortic stenosis

2021 ◽  
pp. 18-24
Author(s):  
S. Yu. Bartosh-Zelenaya ◽  
T. V. Naiden ◽  
A. E. Andreeva ◽  
V. V. Stepanova
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Clinical Significance ◽  
Stress Echocardiography ◽  
Contractile Function ◽  
Stress Test ◽  
Global Longitudinal Strain ◽  
Exercise Stress ◽  
Contractile Reserve ◽  
Exercise Stress Echocardiography

In order to determine the clinical significance of exercise stress echocardiography in patients with severe to moderate aortic stenosis, a stress-induced increase in the mean pressure gradient across the aortic valve was recorded and myocardial contractile reserve was assessed using a number of parameters (ejection fraction, global longitudinal strain, elasticity index). It was found that, with normal values of EF at rest in patients with severe and moderate aortic stenosis, the deficit in contractile function was revealed using the GLS index, which demonstrated a decrease in both groups at the peak of exercise. A decrease in contractile reserve by both parameters (EF and GLS) was found in the group of patients with severe AS, which, combined with a significant stress-induced increase in the gradient on the aortic valve (≥18–20 mm Hg), an increase in pulmonary artery pressure (>  60 mm Hg) and decrease in systemic systolic blood pressure (>20 mm Hg) should be considered as a predictors of a poor prognosis of the natural course of aortic valve disease, and patients with similar stress test results should be possible candidates for surgical aortic valve replacement. A decrease in the in the LV elasticity index augmentation at the peak of exercise, strongly correlated with changes in other considered parameters of contractility and the metabolic power of exercise (MET), significantly complements the functional characteristics of the lesion for choosing the optimal management strategy. Consequently, exercise stress echocardiography is an indispensable diagnostic tool for determining the prognosis and timing of surgery in patients with aortic stenosis.

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