Postextrasystolic Blood Pressure Potentiation Predicts Poor Outcome of Cardiac Patients

Sinnecker, Daniel; Dirschinger, Ralf J.; Barthel, Petra; Müller, Alexander; Morley-Davies, Adrian; Hapfelmeier, Alexander; Dommasch, Michael; Huster, Katharina M.; Hasenfuß, Gerd; Laugwitz, Karl Ludwig; Malík, Marek; Schmidt, Georg

doi:10.1161/jaha.114.000857

Cited by 14 publications

(20 citation statements)

References 35 publications

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“…P 1 /P 2-10 ) at admission were >1.03 in both patients, meaning that both patients would be classified as 'PESP present' according to the definition used in the post-MI study described above. 14 In one of the patients (Patient 1), PESP numerical ratio at discharge decreased to 0.98, re-classifying the patient as 'PESP absent' at this time point. Concomitantly, the NT-proBNP plasma level was also lower at discharge than at admission.…”

Section: Future Directionsmentioning

confidence: 93%

“…14 To establish a new, simply applicable, non-invasive risk predictor, we decided to investigate PESP at the blood pressure level using non-invasive measurements. On days 5-9 after MI, patients underwent a 30-minute recording of ECG and blood pressure.…”

Section: Post-extrasystolic Potentiation As a Risk Predictor In Cardimentioning

confidence: 99%

“…If any of these variables was additionally included in a Cox regression model consisting of PESP, LVEF, VPC count and GRACE score, the association of PESP and mortality remained highly significant. 14 To validate these findings in a different patient population, we analysed data from a previously reported cohort of 146 patients with chronic heart failure, 15 PESP as described above can only be assessed in patients with sinus rhythm. However, in atrial fibrillation, the myocardial force-interval relationship translates the random variability of beat-to-beat intervals into a corresponding pulse pressure variability.…”

Section: Post-extrasystolic Potentiation As a Risk Predictor In Cardimentioning

confidence: 99%

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Post-extrasystolic Blood Pressure Potentiation as a Risk Predictor in Cardiac Patients

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Sinnecker

Barthel

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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In 1885, Oscar Langendorff was the first person to describe the increase in contractility ('Pulsverstärkung') that follows an extrasystole.1 Langendorff experimented with spontaneously beating isolated frog hearts. He recorded the heartbeats by using a lever that transferred the contractile movements of the heart to a rotating drum. Electrical stimulation resulted in premature contractions that were followed by compensatory pauses. In these experiments, he noticed that myocardial contractility during the first post-ectopic beats was typically stronger compared with the normal beats (see Figure 1A). Decades later, this phenomenon was termed postextrasystolic potentiation (PESP).2 PESP is present at the level of the myocardium, independently of pre-or afterload conditions. 3 The driving force behind the augmented post-extrasystolic contractility is augmented calcium release from the intracellular stores during the post-extrasystolic action potential. 4,5 Historically, PESP has been studied intensively with regard to two possible clinical applications (reviewed in Cooper 3 ):• PESP was induced during contrast ventriculography with the aim of identifying ischaemic but viable myocardial regions that might benefit from revascularisation.• PESP was elicited by paired pacing with the aim of augmenting myocardial contractility in heart failure patients.Besides these now widely abandoned applications, several studies have documented an interesting relationship between PESP and myocardial dysfunction. Post-extrasystolic Potentiation and HeartDisease: A Forgotten Association?PESP can be measured as post-extrasystolic augmentation of the maximum left-ventricular pressure rise (LV dP/dt) or as systolic blood pressure potentiation. The parameter that is most closely related to myocardial contractility is LV dP/dt. At the level of LV dP/dt, PESP was observed both in healthy people and in heart failure patients. 6However, potentiation of LV dP/dt was typically more pronounced in failing than in healthy hearts. 7-10 At the level of blood pressure, it has to be taken into account that systolic blood pressure is not only determined by cardiac output, but also by vascular factors, such as peripheral vascular resistance. When PESP was measured at the level of maximum systolic blood pressure (or maximum LV pressure, which are roughly equivalent in the absence of aortic stenosis), the typical finding in healthy probands was that the first post-ectopic heartbeat elicited a lower pulse wave than the regular ones. By contrast, in heart failure patients, PESP of systolic blood pressure could generally be observed. [6][7][8][9][10] In a series of 100 consecutive patients with coronary artery disease, the pattern of post-extrasystolic blood pressure potentiation was associated with an increased prevalence of congestive heart failure and cardiomegaly as well as with higher left-ventricular end-diastolic pressure, lower cardiac output and lower left-ventricular ejection fraction (LVEF). 11At the cellular level, PESP of contractility is caused ...

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Section: Future Directionsmentioning

confidence: 93%

Section: Post-extrasystolic Potentiation As a Risk Predictor In Cardimentioning

confidence: 99%

Section: Post-extrasystolic Potentiation As a Risk Predictor In Cardimentioning

confidence: 99%

See 1 more Smart Citation

Post-extrasystolic Blood Pressure Potentiation as a Risk Predictor in Cardiac Patients

Steger

Sinnecker

Barthel

et al. 2016

Arrhythmia &Amp; Electrophysiology Review

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“…During the screening period of the Autonomic Regulation Trial (ART) [5], we identified 32 patients suffering from acute myocardial infarction (MI) who were excluded from the ART study analyses because of AF [5]. These patients comprised the study cohort of the present analysis.…”

Section: Study Cohortmentioning

confidence: 99%

“…This phenomenon is termed post-extrasystolic potentiation (PESP) [3,4]. Recently, we reported that PESP, measured at the blood pressure level, is a powerful and independent predictor of mortality in survivors of myocardial infarction (MI) [5].…”

Section: Introductionmentioning

confidence: 99%