Arterial Hypertension and Cardiopulmonary Function: The Value of a Combined Cardiopulmonary and Echocardiography Stress Test

Abstract

Arterial hypertension (AH) is a global burden and the leading risk factor for mortality worldwide. Haemodynamic abnormalities, longstanding neurohormonal and inflammatory activation, which are commonly observed in patients with AH, promote cardiac structural remodeling ultimately leading to heart failure (HF) if blood pressure values remain uncontrolled. While several epidemiological studies have confirmed the strong link between AH and HF, the pathophysiological processes underlying this transition remain largely unclear. The combined cardiopulmonary-echocardiography stress test (CPET-ESE) represents a precious non-invasive aid to detect alterations in patients at the earliest stages of HF. The opportunity to study the response of the cardiovascular system to exercise, and to differentiate central from peripheral cardiovascular maladaptations, makes the CPET-ESE an ideal technique to gain insights into the mechanisms involved in the transition from AH to HF, by recognizing alterations that might be silent at rest but influence the response to exercise. Identifications of these subclinical alterations might allow for a better risk stratification in hypertensive patients, facilitating the recognition of those at higher risk of evolution towards established HF. This may also lead to the development of novel preventive strategies and help tailor medical treatment. The purpose of this review is to summarise the potential advantages of using CPET-ESE in the characterisation of hypertensive patients in the cardiovascular continuum.

Novel Strategies in Diagnosing Heart Failure with Preserved Ejection Fraction: A Comprehensive Literature Review

“…The value of a combined CPET and ecochardiography stress test protocol has also been evaluated to further rule-in patients with HFpEF, especially in the earliest stage of the disease when other diagnostic methodologies may have low specificity or not be indicated due to invasiveness [ 89 ].…”

Challenges in Echocardiography for the Diagnosis and Prognosis of Non-Ischemic Hypertensive Heart Disease

“…It is noteworthy that physical exercise has the capacity to stress cardiopulmonary homeostasis and reveal pathological hemodynamic changes that may not be apparent at rest. In addition to the aforementioned changes during DSTE, lower peak values of oxygen consumption (VO 2 ) and end-tidal carbon dioxide (PetCO 2 ), along with a higher ventilatory equivalent for carbon dioxide (VE/VCO 2 ) slope, are independent predictors of masked HFpEF [85,86] This comprehensive diagnostic approach enables timely intervention and personalized management strategies [87,88]. Notably, CPET-ESE has recently demonstrated additional predictive value in patients with subclinical HF compared to the two techniques used separately [89].…”

Novel Techniques, Biomarkers and Molecular Targets to Address Cardiometabolic Diseases

“…To overcome these limitations, the assessment of VAC using a non-invasive, Doppler-derived, single-beat technique has been tested to estimate the aortic arch PWV (aa-PWV) [33]. This measurement requires a hand-drawn centreline in which errors may be produced [34,35]. The distribution of aa-PWV across the whole cardiovascular continuum, from healthy controls to patients with different HF phenotypes, has been recently provided, suggesting aa-PWV as a potential new tool for the stratification of patients at risk or with clinically manifest HF [32].…”