Left Ventricular Restrictive Filling Pattern and the Presence of Contractile Reserve in Patients with Low‐Flow/Low‐Gradient Severe Aortic Stenosis

Mahfouz, Ragab A.; Zayat, Ahmed El; Yousry, Ahmed

doi:10.1111/echo.12586

Cited by 7 publications

(3 citation statements)

References 30 publications

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“…A baseline 12-lead electrocardiogram (ECG) and noninvasive blood pressure were acquired and repeated at 2-min intervals during the exercise test, at peak exertion, and after exercise. The maximum exercise capacity of metabolic equivalents (METs) was recorded, where 1 MET = 3.5 mL/kg/min oxygen consumption was estimated based on the protocol, speed, and grade achieved 14 . Exercise duration and ratio of peak HR to target HR (according to the 220-age formula) were also recorded automatically.…”

Section: Exercise Protocolmentioning

confidence: 99%

Echocardiographic Normal Reference of Left Ventricular Contractile Reserve During Treadmill Exercise Stress Echocardiography in Healthy Chinese Adults – New Non-Sex-Specific Parameter for Left Ventricular Contractile Reserve Evaluation

Wang¹,

Li²,

Zhang³

et al. 2021

IJGM

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Purpose: Left ventricular (LV) contractile reserve is commonly used for LV systolic function assessment, while data on normal LV contractile reserve to exercise and the effect of gender on it are contradictory and limited, especially in Chinese adults. The aims of the present study are to clarify echocardiographic normal reference of LV contractile reserve during treadmill exercise stress echocardiography in healthy Chinese adults and to evaluate the sex-specific impact on it. Patients and Methods:The study population consisted of 157 healthy Chinese adults. All subjects underwent comprehensive echocardiographic assessment at rest and immediately after a symptom-limited treadmill stress test. The impact of gender on LV contractile reserve was analyzed. Results:The study population consisted of 157 healthy Chinese adults. All subjects underwent comprehensive echocardiographic assessment at rest and immediately after a symptomlimited treadmill stress test. The impact of gender on LV contractile reserve was analyzed. Conclusion:Traditional LV contractile reserve of men was much higher than that of women in a healthy Chinese population. The difference might be because of higher BSA in men. ΔGLS was less influenced by METs and CI at rest compared to ΔEF. ΔGLS, and especially the ΔGLS index, might be considered as a more preferable contractile reserve parameter for clinical cardiac function evaluation.

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Section: Exercise Protocolmentioning

confidence: 99%

Echocardiographic Normal Reference of Left Ventricular Contractile Reserve During Treadmill Exercise Stress Echocardiography in Healthy Chinese Adults – New Non-Sex-Specific Parameter for Left Ventricular Contractile Reserve Evaluation

Wang¹,

Li²,

Zhang³

et al. 2021

IJGM

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“…The AS group included symptomatic and asymptomatic patients with varying levels of AS, which may have contributed to between-study heterogeneity. In particular studies with low-flow, low-gradient situations, and LV-EF impairment (70, 71) were analyzed separately as LV mechanics can impact circulatory parameters. Nevertheless, the hemodynamic changes of HR and SV between AS patients with and without low-flow, low-gradient situations did not differ significantly.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients–A Systematic Review and Meta-Analysis

Runte

Brosien

Salcher‐Konrad

et al. 2019

Front. Cardiovasc. Med.

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Introduction: Exercise testing has become a diagnostic standard in the evaluation and management of heart disease. While different methods of exercise and pharmacological stress testing exist, only little is known about their comparability. We aimed to assess hemodynamic changes during dynamic exercise, isometric exercise, and dobutamine stress testing at different stress intensities in healthy subjects and patients with aortic stenosis (AS) and aortic coarctation (CoA). Methods: A systematic literature search (PROSPERO 2017:CRD42017078608) in MEDLINE of interventional trials was conducted to identify eligible studies providing evidence of changes in hemodynamic parameters under different stress conditions acquired by MRI or echocardiography. A random effects model was used to estimate pooled mean changes in hemodynamics. Results: One hundred and twenty-eight study arms with a total of 3,139 stress-examinations were included. In healthy subjects/(where available) in AS, pooled mean changes (95% CIs) during light dynamic stress were 31.78 (27.82–35.74) bpm in heart rate (HR) and 6.59 (2.58–10.61) ml in stroke volume (SV). Changes during light pharmacological stress were 13.71 (7.87–19.56)/14.0 (9.82–18.18) bpm in HR, and 5.47 (0.3–10.63)/8.0 (3.82–12.18) ml in SV. Changes during light isometric stress were 18.44 (10.74–26.14)/5.0 (−1.17–11.17) bpm in HR and −4.17 (−14.37–6.03)/−4.0 (−16.43–8.43) ml in SV. Changes during moderate dynamic stress were 49.57 (40.03–59.1)/46.45 (42.63–50.27) bpm in HR and 11.64 (5.87–17.42) ml in SV. During moderate pharmacological stress, changes in HR were 42.83 (36.94–48.72)/18.66 (2.38–34.93) bpm and in SV 6.29 (−2.0–14.58)/13.11 (7.99–18.23) ml. During high intensity dynamic stress changes in HR were 89.31 (81.46–97.17)/55.32 (47.31–63.33) bpm and in SV 21.31 (13.42–29.21)/−0.96 (−5.27–3.35) ml. During high pharmacological stress, changes in HR were 53.58 (36.53–70.64)/42.52 (32.77–52.28) bpm, and in SV 0.98 (−9.32–11.27)/14.06 (−1.62–29.74) ml. HR increase and age were inversely correlated at high stress intensities. In CoA, evidence was limited to single studies. Conclusion: This systematic review and meta-analysis presents pooled hemodynamic changes under light, moderate and high intensity exercise and pharmacological stress, while considering the potential influence of age. Despite limited availability of comparative studies, the reference values presented in this review allow estimation of the expected individual range of a circulatory response in healthy individuals and patients with AS and may contribute to future study planning and patient-specific models even when stress testing is contraindicated.

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“…The maximum exercise capacity of metabolic equivalents (METs) was recorded, where 1 MET = 3.5 mL/kg/min oxygen consumption was estimated based on the protocol, speed, and grade achieved. 20 Exercise duration and the ratio of peak HR to target HR (according to the 220 − age formula) were also automatically recorded.…”

Section: Exercise Protocolmentioning

confidence: 99%

Stress Echocardiographic Myocardial Work in Healthy Adults and Heart Failure with Preserved Ejection Fraction Patients and Doubt about Early Systolic Lengthening

Huang,

Ye,

Zhang

et al. 2024

Preprint

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Background The aims of this study were (1) to characterize myocardial work (MW) changes from rest to after exercise in healthy adults and heart failure patients with preserved ejection fraction (HFpEF), and (2) to explore the factors influencing the decrease in global work efficiency (GWE) after exercise in healthy adults.Methods This study enrolled 167 healthy adults and 38 HFpEF patients. All subjects underwent echocardiographic assessment at rest and immediately after a symptom-limited treadmill stress test.Results GWE decreased after exercise in healthy adults. It was higher in women after exercise (women: 93% vs. men: 91%, p < 0.05). GWE was significantly lower after exercise in HFpEF patients (HFpEF: 85% vs. healthy: 92%, p < 0.05). The peak positive strain (PPS) was independently associated with global wasted work (GWW) both in healthy adults and HFpEF patients (healthy adults: r = 0.77, p < 0.001 at rest; r = 0.72, p < 0.001 after exercise; HFpEF: r = 0.74, p < 0.001 at rest; and r = 0.62, p < 0.001 after exercise).Conclusions MW parameters were less affected by sex in healthy individuals. MW parameters were lower in HFpEF than healthy adults both at rest and after exercise. GWE decreased in healthy adults after exercise because of increased GWW, and PPS was independently associated with GWW both at rest and under load, suggesting that early systolic lengthening (ESL) may be beneficial for subsequent contraction of the myocardium.

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Left Ventricular Restrictive Filling Pattern and the Presence of Contractile Reserve in Patients with Low‐Flow/Low‐Gradient Severe Aortic Stenosis

Abstract: Restrictive filling pattern of diastolic dysfunction on baseline echo Doppler study may predict lack of contractile reserve in patients with LF/LG severe AS.

Cited by 7 publications

References 30 publications

Echocardiographic Normal Reference of Left Ventricular Contractile Reserve During Treadmill Exercise Stress Echocardiography in Healthy Chinese Adults – New Non-Sex-Specific Parameter for Left Ventricular Contractile Reserve Evaluation

Echocardiographic Normal Reference of Left Ventricular Contractile Reserve During Treadmill Exercise Stress Echocardiography in Healthy Chinese Adults – New Non-Sex-Specific Parameter for Left Ventricular Contractile Reserve Evaluation

Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients–A Systematic Review and Meta-Analysis

Stress Echocardiographic Myocardial Work in Healthy Adults and Heart Failure with Preserved Ejection Fraction Patients and Doubt about Early Systolic Lengthening

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