Echo-derived peak cardiac power output-to-left ventricular mass with cardiopulmonary exercise testing predicts outcome in patients with heart failure and depressed systolic function

Pugliese, Nicola Riccardo; Fabiani, Iacopo; Mandoli, Giulia Elena; Guarini, G; Galeotti, Gian Giacomo; Miccoli, Mario; Lombardo, A; Simioniuc, Anca; Bigalli, G.; Pedrinelli, Roberto; Dini, Frank Lloyd

doi:10.1093/ehjci/jey172

Cited by 42 publications

(29 citation statements)

References 30 publications

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“…Data collected at each stage, that is at baseline, after 4 min, at the AT, and at peak effort, included: left ventricle (LV) and atrial (LA) volumes, stroke volume (SV), peak E-wave and A-wave velocities, tissue Doppler imaging (TDI)-derived S’ and e’ at the septal and lateral mitral annulus, tricuspid regurgitation velocity and systolic pulmonary artery pressure (sPAP), tricuspid annular plane systolic excursion (TAPSE); LV volumes and LVEF were calculated from the apical two- and four-chamber views using the modified Simpson’s rule. SV was calculated by multiplying the LV outflow tract area at rest by the LV outflow tract velocity–time integral measured by pulsed-wave Doppler during each activity level, as previously validated [ 20 – 23 ]. Cardiac output was calculated as the multiplication of SV and HR.…”

Section: Methodsmentioning

confidence: 99%

Mechanisms of reduced peak oxygen consumption in subjects with uncomplicated type 2 diabetes

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Pugliese

Sciuto

et al. 2021

Cardiovasc Diabetol

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Background Type 2 diabetes mellitus (T2D) increases the risk of incident heart failure (HF), whose earliest fingerprint is effort intolerance (i.e. impaired peak oxygen consumption, or VO2peak). In the uncomplicated T2D population, however, the prevalence of effort intolerance and the underpinning mechanistic bases are uncertain. Leveraging the multiparametric characterization allowed by imaging-cardiopulmonary exercise testing (iCPET), the aim of this study is to quantify effort intolerance in T2D and to dissect the associated cardiopulmonary alterations. Methods Eighty-eight adults with well-controlled and uncomplicated T2D and no criteria for HF underwent a maximal iCPET with speckle tracking echocardiography, vascular and endothelial function assessment, as well as a comprehensive biohumoral characterization. Effort intolerance was defined by a VO2peak below 80% of maximal predicted oxygen uptake. Results Forty-eight patients (55%) had effort intolerance reaching a lower VO2peak than T2D controls (16.5 ± 3.2 mL/min/kg, vs 21.7 ± 5.4 mL/min/kg, p < 0.0001). Despite a comparable cardiac output, patients with effort intolerance showed reduced peak peripheral oxygen extraction (11.3 ± 3.1 vs 12.7 ± 3.3 mL/dL, p = 0.002), lower VO2/work slope (9.9 ± 1.2 vs 11.2 ± 1.4, p < 0.0001), impaired left ventricle systolic reserve (peak S’ 13.5 ± 2.8 vs 15.2 ± 3.0, p = 0.009) and global longitudinal strain (peak-rest ΔGLS 1.7 ± 1.5 vs 2.5 ± 1.8, p = 0.03) than subjects with VO2peak above 80%. Diastolic function, vascular resistance, endothelial function, biohumoral exams, right heart and pulmonary function indices did not differ between the two groups. Conclusions Effort intolerance and reduced VO2peak is a severe and highly prevalent condition in uncomplicated, otherwise asymptomatic T2D. It results from a major defect in skeletal muscle oxygen extraction coupled with a subtle myocardial systolic dysfunction.

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Section: Methodsmentioning

confidence: 99%

Mechanisms of reduced peak oxygen consumption in subjects with uncomplicated type 2 diabetes

Nesti

Pugliese

Sciuto

et al. 2021

Cardiovasc Diabetol

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“…Cardiac power is a comprehensive quantitative indicator and can evaluate cardiac function via noninvasive echocardiography [4,5,19]. It is better than variables such as cardiac output because it covers both pressure load and volume load [20].…”

Section: Discussionmentioning

confidence: 99%

“…It is better than variables such as cardiac output because it covers both pressure load and volume load [20]. Since the power depends on the volume of the muscle that produces the power, standardizing cardiac power with LV mass can better evaluate the applicability of this indicator in different populations [4,6,19], and also facilitate the comparison between individuals.…”

Section: Discussionmentioning

confidence: 99%

Rest Cardiac Power Predicts All-cause Death and Heart Failure Hospitalization in Heart Failure Patients With Preserved Ejection Fraction

Chen

Hao

et al. 2021

Preprint

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Background: Cardiac power as an integrated indicator of cardiac performance that incorporates both pressure and volume factors. It has been studied in patients with reduced left ventricular (LV) ejection fraction (EF), and in the present study we aimed to explore its significance and role in predicting adverse outcome in patients with heart failure with preserved ejection fraction (HFpEF).Methods: This retrospective cohort study included 2089 community-dwelling patients with HFpEF and without significant valve diseases or right ventricular dysfunction. We normalized cardiac power to LV mass and expressed it in W/100 g of LV myocardium. Univariate analysis with log-rank test and multivariate analysis with Cox regression model were used to evaluate the association between rest cardiac power/mass and all-cause death and heart failure (HF) hospitalization. Results: After a median follow-up of 4.4 (0.5–10.1) years, 331 (15.84%) experienced all-cause death and 391 (18.72%) experienced HF hospitalization. Patients with the lower rest power/mass were older and had higher New York Heart Association class, N-terminal pro-brain natriuretic peptide (NT-proBNP) level and more comorbidities. After adjusting for multiple covariates, rest power/mass ≤0.7 W/m2 was independently associated with all-cause death and HF hospitalization, with the hazard ratio (HR) of 1.753 [95% confidence interval (CI) 1.394–2.203, P<0.001] and 1.266 (95% CI 1.033–1.551, P=0.023), respectively. The C statistic increased significantly when the rest cardiac power/mass were incorporated into a model with established risk factors. For all-cause death, the continuous net reclassification index (NRI) after adding rest cardiac power/mass in the model with established risk factors and NT-proBNP was 17.0% (95% CI 11.4–28.3, P=0.04), and the integrated discrimination index (IDI) was 2.3% (95% CI 0.7–8.7, P=0.02); for HF hospitalization, the corresponding continuous NRI and IDI were 6.0% (95% CI 4.7–15.2, P=0.026) and 1.7% (95% CI 1.2–4.3, P=0.007), respectively.Conclusion: Rest cardiac power by non-invasive echocardiography is independently associated with risks of adverse outcomes in patients with HFpEF and provides incremental prognostic information.

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“…the exercise stress echocardiography-derived peak CPO to mass may contribute to the evaluation of functional status in patients with HF. 16 Although these estimations by echocardiography are safe, rapid, and non-invasive, the estimation of stroke volume depends on the accurate assessment of the LV outflow tract, so obtaining consistent values between institutions and observers is challenging. The cardiopulmonary exercise test also has been used to calculate peak CO and stratify patients with chronic HF.…”

Section: Conflict Of Interestmentioning

confidence: 99%

Prognostic value of resting cardiac power index depends on mean arterial pressure in dilated cardiomyopathy

et al. 2021

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AimsIn recent decades, haemodynamic parameters have been estimated for risk stratification and determining treatment strategies for patients with non-ischaemic dilated cardiomyopathy (DCM). In various invasive procedures, the cardiac pumping capability is defined as cardiac power output (CPO), which is calculated by multiplying cardiac output by the mean arterial pressure. Lower CPO values in advanced heart failure predict adverse outcomes. However, few studies discuss the prognostic value of CPO in mild-to-moderate phase patients. This study aimed to determine the value of the cardiac power index (CPI) obtained from the resting CPO for predicting the prognosis of patients with New York Heart Association Functional Class II or III DCM. Methods and results From March 2000 to January 2020, a total of 623 cardiomyopathy patients were evaluated for haemodynamic parameters. Patients with secondary cardiomyopathy, ischaemic cardiomyopathy, valvular heart disease, and Class IV cardiomyopathy were excluded. A total of 176 DCM patients fulfilled the criteria for inclusion. Patients were 51.7 ± 12.5 years old (mean ± standard deviation) with a mean left ventricular ejection fraction of 32.1 ± 9.2%. The patients were divided into two groups by their median CPI (CPI < 0.52, low-CPI; CPI ≥ 0.52, high-CPI). No significant differences were found in the left ventricular end-diastolic diameter, left ventricular ejection fraction, or pulmonary arterial wedge pressure between the groups. The probability of cardiac event-free survival was significantly lower for low-CPI than for high-CPI groups by Kaplan-Meier analysis (P = 0.012), even with no significant difference between the high and low cardiac index groups (P = 0.069). Furthermore, Cox proportional hazards regression analysis revealed that, in addition to the CPI, the systolic and mean arterial pressure involved in CPI calculation were independent predictors of cardiac events. Indeed, among these factors, mean arterial pressure had the strongest prognostic ability. Conclusions Although CPI is effective for stratifying DCM and predicting cardiac events in patients with Class II/III DCM, this prognostic value depends on mean arterial pressure.

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Echo-derived peak cardiac power output-to-left ventricular mass with cardiopulmonary exercise testing predicts outcome in patients with heart failure and depressed systolic function

Cited by 42 publications

References 30 publications

Mechanisms of reduced peak oxygen consumption in subjects with uncomplicated type 2 diabetes

Mechanisms of reduced peak oxygen consumption in subjects with uncomplicated type 2 diabetes

Rest Cardiac Power Predicts All-cause Death and Heart Failure Hospitalization in Heart Failure Patients With Preserved Ejection Fraction

Prognostic value of resting cardiac power index depends on mean arterial pressure in dilated cardiomyopathy

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