Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography

Journal of Clinical Medicine

on behalf of the Stress Echo 2020 Study Group of the Italian Society of Cardiovascular Imaging¹  Michele De Nes²  Clara Carpeggiani²  Eugenio Picano²  Rodolfo Citro³  Ines Monte⁴  Pablo Martin Merlo⁵  Jorge Lowenstein⁵  Rosina Arbucci⁵  Diego M. Lowenstein Haber⁵  Branko Beleslin⁶  Nikola Boskovic⁶  Vojislav Giga⁶  Milorad Tesic⁶  Ana Djordjevic-Dikic⁶  Nicola Gaibazzi⁷  Michael Salamè⁸  Miguel Amor⁸  Hugo Mosto⁸  Angela Zagatina⁹  Lauro Cortigiani^1,10  Quirino Ciampi^1,11  Clarissa Borguezan Daros^1,12  Doralisa Morrone^1,13  Mauro Pepi^1,14  Tonino Bombardini^1,15  Tamara Kovačević-Preradović^1,15  Miodrag Ostojic^1,15  Karina Wierzbowska-Drabik^1,16  Jaroslaw D. Kasprzak^1,16  Marco A. R. Torres^1,17  Antonello D'Andrea^1,18  Patricia A. Pellikka^1,19  Adelaide M. Arruda-Olson^1,19  Iana Simova^2,20  Martina Samardjieva^2,20  Francesco Antonini-Canterin^2,21  José Luis de Castro e Silva Pretto^2,22  Maria Chiara Scali^2,23 

[1]

[2]Biomedicine Department, CNR, Institute of Clinical Physiology, 56124 Pisa, Italy

[3]Cardio-Thoracic-Vascular-Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84125 Salerno, Italy

[4]Cardio-Thorax-Vascular Department, Echocardiography Lab, Policlinico Vittorio Emanuele, Catania University, 95124 Catania, Italy

[5]Cardiodiagnosticos, Investigaciones Medicas, C1082 ACB Buenos Aires, Argentina

[6]Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia

[7]Cardiology Department, Parma University Hospital, 43100 Parma, Italy

[8]Cardiology Department, Ramos Mejia Hospital, C1221 ADC Buenos Aires, Argentina

[9]Cardiology Department, Saint Petersburg University Clinic, Saint Petersburg University, 199034 St Petersburg, Russia

[10]Cardiology Department, San Luca Hospital, 55100 Lucca, Italy

[11]Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy

[12]Cardiology Division, Hospital San José, 88801-250 Criciuma, Brazil

[13]Cardiothoracic Department, University of Pisa, 56100 Pisa, Italy

[14]Centro Cardiologico Monzino, IRCCS, 20138 Milano, Italy

[15]Clinical Center of The Republic of Srpska, Faculty of Medicine, University of Banja-Luka, 78000 Banja-Luka, Bosnia and Herzegovina

[16]Department of Cardiology, Bieganski Hospital, Medical University, 93-487 Lodz, Poland

[17]Department of Cardiology, Federal University of Rio Grande do Sul, 90040-060 Porto Alegre, Brazil

[18]Department of Cardiology-Umberto I° Hospital Nocera Inferiore (Salerno)-L. Vanvitelli University of Campania, 84014 Nocera Inferiore, Italy

[19]Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55901, USA

[20]Heart and Brain Center of Excellence, University Hospital, 5800 Sofia, Bulgaria

[21]Highly Specialized Rehabilitation Hospital Motta di Livenza, Cardiac Prevention and Rehabilitation Unit, 31045 Treviso, Italy

[22]Hospital Sao Vicente de Paulo e Hospital de Cidade, 99010-080 Passo Fundo, Brazil

[23]Nottola Cardiology Division, 53045 Siena, Italy

关键词: cardiac reserve;    end-diastolic volume;    end-systolic volume;    heart rate;    stress echocardiography;   

DOI  :  10.3390/jcm10132906

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown