Exercise Systolic Reserve and Exercise Pulmonary Hypertension Improve Diagnosis of Heart Failure With Preserved Ejection Fraction

Verwerft, Jan; Verbrugge, Frederik H.; Claessen, Guido; Herbots, Lieven; Dendale, Paul; Gevaert, Andreas B.

doi:10.3389/fcvm.2022.814601

Cited by 5 publications

(4 citation statements)

References 30 publications

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“…5 In Jessa Hospital, the tricuspid regurgitation envelope was enhanced by the routine administration of agitated colloid (Gelofusine 4%, Braun, Melsungen, Germany) at rest and intermediate and peak exercise to maximize feasibility and reproducibility, as previously described (Supplemental Methods S3; Figure S1). 18 The mPAP/CO slope was calculated by linear regression through 3 data points (mPAP and CO at rest and at intermediate and peak exercise; Supplemental Methods). mPAP was derived from the TRG without adding a right atrial pressure estimation using the Chemla formula.…”

Section: Methodsmentioning

confidence: 99%

“…5 In Jessa Hospital, the tricuspid regurgitation envelope was enhanced by the routine administration of agitated S1). 18 The mPAP/CO slope was calculated by linear regression through 3 data points (mPAP and CO at rest and at intermediate and peak exercise; Supplemental Methods). mPAP was derived from the TRG without adding a right atrial pressure estimation using the Chemla formula.…”

Section: Echocardiographymentioning

confidence: 99%

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mPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis

Hoedemakers,

Pugliese,

Stassen

et al. 2024

Circulation

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BACKGROUND: Recent guidelines redefined exercise pulmonary hypertension as a mean pulmonary artery pressure/cardiac output (mPAP/CO) slope >3 mm Hg·L −1 ·min −1 . A peak systolic pulmonary artery pressure >60 mm Hg during exercise has been associated with an increased risk of cardiovascular death, heart failure rehospitalization, and aortic valve replacement in aortic valve stenosis. The prognostic value of the mPAP/CO slope in aortic valve stenosis remains unknown. METHODS: In this prospective cohort study, consecutive patients (n=143; age, 73±11 years) with an aortic valve area ≤1.5 cm 2 underwent cardiopulmonary exercise testing with echocardiography. They were subsequently evaluated for the occurrence of cardiovascular events (ie, cardiovascular death, heart failure hospitalization, new-onset atrial fibrillation, and aortic valve replacement) during a follow-up period of 1 year. Findings were externally validated (validation cohort, n=141). RESULTS: One cardiovascular death, 32 aortic valve replacements, 9 new-onset atrial fibrillation episodes, and 4 heart failure hospitalizations occurred in the derivation cohort, whereas 5 cardiovascular deaths, 32 aortic valve replacements, 1 new-onset atrial fibrillation episode, and 10 heart failure hospitalizations were observed in the validation cohort. Peak aortic velocity (odds ratio [OR] per SD, 1.48; P =0.036), indexed left atrial volume (OR per SD, 2.15; P =0.001), E/e’ at rest (OR per SD, 1.61; P =0.012), mPAP/CO slope (OR per SD, 2.01; P =0.002), and age-, sex-, and height-based predicted peak exercise oxygen uptake (OR per SD, 0.59; P =0.007) were independently associated with cardiovascular events at 1 year, whereas peak systolic pulmonary artery pressure was not (OR per SD, 1.28; P =0.219). Peak V o 2 (percent) and mPAP/CO slope provided incremental prognostic value in addition to indexed left atrial volume and aortic valve area ( P <0.001). These results were confirmed in the validation cohort. CONCLUSIONS: In moderate and severe aortic valve stenosis, mPAP/CO slope and percent-predicted peak V o 2 were independent predictors of cardiovascular events, whereas peak systolic pulmonary artery pressure was not. In addition to aortic valve area and indexed left atrial volume, percent-predicted peak V o 2 and mPAP/CO slope cumulatively improved risk stratification.

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Section: Methodsmentioning

confidence: 99%

Section: Echocardiographymentioning

confidence: 99%

mPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis

Hoedemakers,

Pugliese,

Stassen

et al. 2024

Circulation

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“… 4 While iCPET facilities are limited worldwide, exercise testing with transthoracic echocardiogram (TTE) and non-invasive CPET are widely available. 5 However, cardiac output assessment via TTE with exercise is reported to be underestimated, 6 which may be due to unaccounted change in ventricular outflow tract area with exercise.…”

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confidence: 99%

“…RVOTd was reverse engineered from the TTE-derived RVOT VTI and iCPET-derived stroke volume, using the formula: Fick stroke volume = RVOT VTI × RVOT area (wherein RVOT area = π × [RVOTd/2]2). 5 , 6 Paired observations were compared by paired t -test between RVOTd at rest and subsequent stages in the protocol (leg-raise, exercise stages). The association of change in RVOTd with predictors [cardiac output, heart rate, mean pulmonary artery pressure (mPAP), right ventricular systolic pressure (RVSP), and end-diastolic pressure (RVEDP)] was investigated through linear regression models (or ANCOVA models) adjusting for subject intercept, in which each subject was treated as a categorical variable.…”

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confidence: 99%

Right ventricular outflow tract diameter change with exercise: a prospective exercise echocardiography and invasive CPET study

El Shaer,

Garcia-Arango,

Korcarz

et al. 2024

European Heart Journal - Imaging Methods and Practice

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While cardiac output reserve with exercise predicts outcomes in cardiac and pulmonary vascular disease, precise quantification of exercise cardiac output requires invasive cardiopulmonary testing (iCPET). To improve the accuracy of cardiac output reserve estimation with transthoracic echocardiography (TTE), this prospective study aims to define changes in right ventricular outflow tract diameter (RVOTd) with exercise and its relationship with invasively measured hemodynamics. 20 subjects underwent simultaneous TTE and iCPET, with data collected at rest, leg-raise, 25W, 50W (n = 16), 75W (n = 14), 100W (n = 6). This was followed by a second exercise study with real-time RV pressure-volume loops at similar stages (except leg-raise). The overall cohort included heart failure with preserved ejection fraction (n = 12), pulmonary arterial hypertension (n = 5), and non-cardiac dyspnea (n = 3).RVOTd was reverse engineered from the TTE-derived RVOT velocity time integral (VTI) and iCPET-derived stroke volume, using the formula: Fick stroke volume = RVOT VTI x RVOT area (wherein RVOT area = π x [RVOTd/2]2). RVOTd increased by nearly 3-4% at every 25W increment. Using linear regression models, where each subject is treated as a categorical variable and adjusting for subject intercept, RVOTd was correlated with hemodynamic variables (cardiac output, heart rate, pulmonary artery and RV pressures). Of all the predictor hemodynamic variables, cardiac output had the highest r2 model fit (adjusted r2 = 0.68), with a unit increase in cardiac output associated with a 0.0678 increase in RVOTd (p < 0.001). Our findings indicate that RVOTd increases by 3-4% with every 25W increment, predominantly correlated with cardiac output augmentation. These results can improve the accuracy of cardiac output reserve estimation by adjusting for RVOTd with graded exercise during noninvasive CPET and echocardiogram. However, future studies are needed to define these relationships for left ventricular outflow tract diameter.

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Pulmonary hypertension during exercise underlies unexplained exertional dyspnoea in patients with Type 2 diabetes

Gojevic

Ryckeghem

Jogani

et al. 2022

European Journal of Preventive Cardiology

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Aim To compare the cardiac function and pulmonary vascular function during exercise between dyspneic and non-dyspneic patients with type 2 diabetes mellitus (T2DM). Methods 47 T2DM patients with unexplained dyspnea and 50 asymptomatic T2DM patients underwent exercise echocardiography combined with ergospirometry. Left ventricular (LV) function (stroke volume, cardiac output, LV ejection fraction, systolic annular velocity (s’)), estimated LV filling pressures (E/e’), mean pulmonary arterial pressures (mPAP) and mPAP/COslope were assessed at rest, low- and high-intensity exercise with colloid contrast. Results Groups had similar patient characteristics, glycemic control, stroke volume, cardiac output, LV ejection fraction and E/e’ (p > 0.05). The dyspneic group had significantly lower systolic LV reserve at peak exercise (s’) (p = 0.021) with a significant interaction effect (p < 0.001). The dyspneic group also had significantly higher mPAP and mPAP/CO at rest and exercise (p < 0.001) with significant interaction for mPAP (p < 0.009) and insignificant for mPAP/CO (p = 0.385). There was no significant difference in mPAP/COslope between groups (p = 0.706). However, about 61% of dyspneic vs. 30% of non-dyspneic group had mPAP/COslope > 3 (p = 0.009). The mPAP/COslope negatively predicted V̇O2peak in dyspneic group (β= -1.86, 95% CI -2.75, -0.98; multivariate model R²:0.54). Conclusion Pulmonary hypertension and less LV systolic reserve detected by exercise echocardiography with colloid contrast underlie unexplained exertional dyspnea and reduced exercise capacity in T2DM.

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Exercise Systolic Reserve and Exercise Pulmonary Hypertension Improve Diagnosis of Heart Failure With Preserved Ejection Fraction

Cited by 5 publications

References 30 publications

mPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis

mPAP/CO Slope and Oxygen Uptake Add Prognostic Value in Aortic Stenosis

Right ventricular outflow tract diameter change with exercise: a prospective exercise echocardiography and invasive CPET study

Pulmonary hypertension during exercise underlies unexplained exertional dyspnoea in patients with Type 2 diabetes

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