Citations 1
Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography
Bombardini, Tonino, Zagatina, A , Ciampi, Quirino , Arbucci, Rosina , Merlo, Pablo , Haber, Diego M. Lowenstein, Morrone, Doralisa , Djordjevic‐Dikic, Ana , Tešić, Milorad , Boskovic, N , Giga, Vojislav , Pretto, José de Castro e Silva, Daros, Clarissa Borguezan , Amor, Miguel , Mosto, Hugo , Salamè, Michael, Citro, Rodolfo , Simova, Iana , Samardjieva, Martina, Wierzbowska‐Drabik, Karina , Kasprzak, Jarosław D. , Gaibazzi, Nicola , Cortigiani, Lauro , Scali, Maria Chiara, Antonini‐Canterin, Francesco, Torres, Marco Antônio Rodrigues , Nes, Michele De, Ostojić, Miodrag , Carpeggiani, Clara , Arruda‐Olson, Adelaide M. , Pellikka, Patricia A. , Imaging, on behalf of the Stress Echo 2020 Study Group of the Italian Society of Cardiovascular, D'Andrea, Antonello , Tesic, Milorad , Amor, Miguel , Monte, Ines , Pellikka, Patricia A , Ciampi, Quirino , Zagatina, Angela , Wierzbowska-Drabik, Karina , Kasprzak, Jaroslaw D , Gaibazzi, Nicola , Morrone, Doralisa , Arbucci, Rosina , Citro, Rodolfo , D’Andrea, Antonello , Beleslin, Branko , Pretto, José Luis de Castro e Silva , Monte, Ines , Pepi, Mauro , Kovačević-Preradović, Tamara , Lowenstein, Jorge , Imaging, on behalf of the Stress Echo 2020 Study Group of the Italian Society of Cardiovascular
Journal of Clinical Medicine | June 29, 2021 | Volume: 10 | Issue: 13 | Pages: 2906
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.