Cardiovascular reserve in idiopathic dilated cardiomyopathy as determined by exercise response during cardiac catheterization

Latham, Ricky D.; Thornton, John W.; Mulrow, John P.

doi:10.1016/0002-9149(87)90923-4

Cited by 19 publications

(12 citation statements)

References 20 publications

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“…30,31 There are few data on RV contractile reserve and no standardized methods for how to measure it. LV contractile reserve has been estimated by invasively 30,32 or noninvasively measured changes in LV ejection fraction, 33 radionuclide stroke volume, 26 and cardiac power (aortic pressure times aortic flow) 25 or by echocardiographic parameters of LV function, including wall thickness. 27,28 There have been no studies on RV contractile reserve in patients with right heart failure caused by PAH or CTEPH.…”

Section: Measurements Of Contractile Reserve In Heart Failurementioning

confidence: 99%

Assessment and Prognostic Relevance of Right Ventricular Contractile Reserve in Patients With Severe Pulmonary Hypertension

et al. 2013

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R ight ventricular (RV) pump function is of essential clinical and prognostic importance in a variety of heart and lung diseases and in pulmonary arterial hypertension (PAH). [1][2][3][4][5] Survival in pulmonary hypertension (PH) patients depends on the capability of the RV to adapt to chronically elevated pulmonary artery pressures. 6 Therefore, an accurate evaluation of RV pump function is crucial for screening, diagnosis, and follow-up assessment in PH. 7 However, it is difficult to assess RV function because of its complex geometry and load dependence and because of inadequate standardization of the assessment. 8 This is true for both noninvasive and invasive techniques.Evaluation of RV performance in PH patients has been recommended to be obtained at rest. 9 It is unknown whether assessment of RV function during exercise may be of additional benefit or even preferable. According to clinical experience, some PH patients with a severely enlarged right side of the heart and impaired RV pump function at rest do much better in their exercise capacity, World Health Organization functional class, and quality of life than others. They might differ in their RV reserve, defined as the ability of the ventricle to increase ejection fraction and stroke volume during exercise or pharmacological stress.10,11 RV and left ventricular (LV) contractileBackground-This study sought to analyze a new approach to assess exercise-induced pulmonary artery systolic pressure (PASP) increase by means of stress Doppler echocardiography as a possible measure of right ventricular contractile reserve in patients with severe pulmonary hypertension and right heart failure. Methods and Results-In this prospective study, patients with invasively diagnosed pulmonary arterial hypertension or inoperable chronic thromboembolic pulmonary hypertension and impaired right ventricular pump function despite a stable targeted pulmonary arterial hypertension medication underwent a broad panel of noninvasive assessments, including stress echocardiography and cardiopulmonary exercise testing. On the basis of the assumption that exerciseinduced PASP is a measure of right ventricular contractile reserve, patients were classified into 2 groups according to an exercise-induced PASP increase above or below the median. Patients were followed up for 3.0±1.8 years. Univariate and multivariate analyses were used for factors predicting survival. Of 124 patients, 66 were below the median exerciseinduced PASP increase of 30 mm Hg (low PASP), and 58 patients were above the median (high PASP). These groups were not significantly different in terms of medication and resting hemodynamics. Low PASP was associated with a significantly lower 6-minute walking distance, peak Vo 2 per kilogram, and 1-, 3-, and 4-year survival rates (92%, 69%, and 48%, respectively, versus 96%, 92%, and 89%). In the multivariate Cox model analysis adjusted for age and sex, PASP increase during exercise and peak Vo 2 per kilogram remained independent prognostic markers (hazard ratio, 2.56 for pea...

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Section: Measurements Of Contractile Reserve In Heart Failurementioning

confidence: 99%

Assessment and Prognostic Relevance of Right Ventricular Contractile Reserve in Patients With Severe Pulmonary Hypertension

et al. 2013

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“…Urađen je veći broj studija u kojima su kao inotropi korišćeni farmakološki agensi (dobutamin, dipiridamol) [4,5], a znatno ređe fizički napor [6]. Ove studije su pokazale da je očuvana kontraktilna rezerva udružena sa blažom formom srčane insuficijencije i/ili da identifikuje bolesnike sa boljom prognozom.…”

Section: Uvodunclassified

“…To je od značaja za pravilnu selekciju i povećani nadzor ovih pacijenata, jer je više studija pokazalo da oni imaju značajno lošiju prognozu u poređenju sa pacijentima koji imaju očuvanu kontraktilnu rezervu leve komore (4,5,6).…”

Section: Diskusijaunclassified

Differences in the clinical characteristics of patients with dilated cardiomyopathy, depending on the presence of preserved left ventricular contractile reserve assessed by exercise stress-echo-cardiography

Perić¹,

Jovanovic²,

Rašić³

et al. 2014

Praxis Med

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Očuvana kontraktilna rezerva leve komore podrazumeva sposobnost hipokinetičnih segmenata miokarda da pod dejstvom različitih inotropnih stimulusa poprave svoju kontraktilnost. Utvrditi razlike u kliničkim karakteristikama kod pacijenata sa dilatacionom kardiomiopatijom u zavisnosti od očuvane kontraktilne rezerve leve komore. U studiju je uključeno uzastopnih 55 bolesnika sa idiopatskom dilatativnom kardiomiopatijom. Svim bolesnicima uključenim u studiju urađen je stres ehokardiografski test fizičkim opterećenjem po standardnom protokolu. Postojanje očuvane kontraktilne rezerve je određivano uz pomoć promene ejekcione frakcije leve komore. Prosečna starost ispitivanih bolesnika je bila 54,98 ± 9,84 godina, 49 (89,1%) je bilo muškog pola. Na osnovu promene ejekcione frakcije leve komore kao kriterijuma kontraktilne rezerve leve komore, očuvanu kontraktilnu rezervu je imalo 25 bolesnika (45,5%). Bolesnici bez očuvane kontraktilne rezerve leve komore znatno češće u anamnezi imaju zastupljenu arterijsku hipertenziju (46,7 vs. 20,0%, p=0,038). Nema značajne razlike u zastupljenosti ostalih faktora rizika. Pacijenti sa očuvanom kontraktilnom rezervom leve komore imaju manju dimenziju leve komore na kraju sistole (49,64 ± 7,26 vs. 55,27 ± 8,36 mm, p=0.011), manji indeks volumena leve komore na kraju dijastole (77,35 ± 26,41 vs. 94,59 ± 34,97 ml/m2, p=0,005) i na kraju sistole (59,31 ± 26,05 vs. 78,62 ± 34,42 ml/m2, p=0,002), veću ejekcionu frakciju leve komore (25,48 ± 8,32 vs. 18,33 ± 6,49%, p=0,002) i niži indeks pokreta zidova leve komore (2,23 ± 0,27 vs. 2,48 ± 0,27, p=0,002). Kod bolesnika sa očuvanom kontraktilnom rezervom leve komore nalazimo manju zastupljenost arterijske hipertenzije i morfološki i funkcionalno manje oštećenu levu komoru.Ključne reči: arterijska hipertenzija, kontraktilna rezerva, dilataciona kardiomiopatija. UVODDilatativna kardiomiopatija se karakteriše proširenj-em i poremećenom sistolnom funkcijom leve ili obe srčane komore u odsustvu drugih težih bolesti. Prilikom postavljanja dijagnoze dilatacione kardiomiopatije treba pre svega isključiti postojanje značajne hipertenzije, primarne valvularne bolesti, značajne koronarne arterijske bolesti i kongenitalnih bolesti srca. Dilatacija i disfunkcija desne komore srca, kao i dijastolna disfunkcija leve komore mogu biti prisutne, ali nisu neophodne za dijagnozu dila¬tativne kardiomiopatije [1,2]. U 50% ili više bolesnika sa dilatativnom kardiomiopatijom etiološki uzrok se ne može odrediti i u tom slučaju se u kliničkoj medicini govori o idiopatskoj dilatativnoj kardiomiopatiji [3].Očuvana kontraktilna rezerva leve komore podrazumeva sposobnost hipokinetičnih segmenata miokarda da pod dejstvom različitih inotropnih stimulusa poprave svoju kontraktilnost. Urađen je veći broj studija u kojima su kao inotropi korišćeni farmakološki agensi (dobutamin, dipiridamol) [4,5], a znatno ređe fizički napor [6]. Ove studije su pokazale da je očuvana kontraktilna rezerva udružena sa blažom formom srčane insuficijencije i/ili da identifikuje bolesnike sa boljom...

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“…Contractile reserve was most frequently assessed using pharmacological agents, such as dobutamine and dipyridamole, 2,3) but rarely using physical exertion. 4) It has been clearly demonstrated that preserved left ventricular contractile reserve was associated with milder forms of heart failure and identified patients with better prognosis. [2][3][4] The most important clinical use of BNP is to separate left ventricular dysfunction from other causes of dyspnea.…”

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confidence: 99%

“…4) It has been clearly demonstrated that preserved left ventricular contractile reserve was associated with milder forms of heart failure and identified patients with better prognosis. [2][3][4] The most important clinical use of BNP is to separate left ventricular dysfunction from other causes of dyspnea. [5][6][7] The diagnostic and prognostic value of BNP measurements at rest in patients with heart failure is very well documented, but the potential clinical implications of changes in BNP during physical exertion in these patients are much less clear.…”

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confidence: 99%

Temporal Changes in Plasma Brain Natriuretic Peptide Levels During Exercise Stress-Echocardiography in Patients With Dilated Cardiomyopathy

et al. 2014

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SummaryThe aim of this study was to evaluate temporal changes in brain natriuretic petide (BNP) levels during exercise stress-echocardiography in patients with dilated cardiomyopathy with respect to the left ventricular contractile reserve. We studied 55 consecutive patients with dilated cardiomyopathy (mean age, 55 ± 10 years, 49 (89.1%) male). All patients underwent exercise stress-echocardiography on a treadmill using the modified Bruce protocol. Contractile reserve was assessed by measuring changes in the wall motion score index (ΔWMSI) at rest and and at peak exercise. Levels of BNP were measured at rest, in the first minute, and after 20 minutes following termination of the stress test. Thirty-six patients had preserved left ventricular contractile reserve and 19 patients did not. Patients with preserved left ventricular contractile reserve showed a continuous rise in BNP levels from baseline to peak exercise and to 20 minutes following exertion (83.95 ± 108.51 versus 105.89 ± 116.00 versus 110.95 ± 119.70 ng/L, P < 0.001, respectively). On the other hand, patients without preserved left ventricular contractile reserve showed a decline in BNP levels at peak exercise as compared to baseline (335.49 ± 693.11 versus 320.08 ± 562.60, P = 0.031). ΔBNP was positively correlated with preserved contractile reserve (r = 0.46, P = 0.03) and lower NYHA class (r = -0.65, P = 0.001) in patients in whom baseline LVEF was lower than 20%. Multivariate analysis identified only WMSI at rest (beta -3.365, P = 0.008, 95% CI 0.03 to 0.411) as an independent predictor of left ventricular contractile reserve.The increase in BNP levels during exercise stress-echocardiography is associated with preserved left ventricular contractile reserve in patients with dilated cardiomyopathy. ( 1) Left ventricular contractile reserve has been identified as one of the major prognostic indicators. Contractile reserve was most frequently assessed using pharmacological agents, such as dobutamine and dipyridamole, 2,3) but rarely using physical exertion.4) It has been clearly demonstrated that preserved left ventricular contractile reserve was associated with milder forms of heart failure and identified patients with better prognosis. 2-4)The most important clinical use of BNP is to separate left ventricular dysfunction from other causes of dyspnea.5-7) The diagnostic and prognostic value of BNP measurements at rest in patients with heart failure is very well documented, but the potential clinical implications of changes in BNP during physical exertion in these patients are much less clear.There are initial reports indicating that the NT-pro BNP changes in response to dobutamine reflect improvement in left ventricular contractility and constitute an independent predictor of left ventricular inotropic reserve in patients with dilated cardiomyopathy, 8) and although resting NT-pro BNP levels can be used as a surrogate risk predictor, their changes during betaadrenergic stimulation showed no additive predictive value in assessing the clinical outcome...

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Cardiovascular reserve in idiopathic dilated cardiomyopathy as determined by exercise response during cardiac catheterization

Cited by 19 publications

References 20 publications

Assessment and Prognostic Relevance of Right Ventricular Contractile Reserve in Patients With Severe Pulmonary Hypertension

Assessment and Prognostic Relevance of Right Ventricular Contractile Reserve in Patients With Severe Pulmonary Hypertension

Differences in the clinical characteristics of patients with dilated cardiomyopathy, depending on the presence of preserved left ventricular contractile reserve assessed by exercise stress-echo-cardiography

Temporal Changes in Plasma Brain Natriuretic Peptide Levels During Exercise Stress-Echocardiography in Patients With Dilated Cardiomyopathy

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