Practical guidance for the implementation of stress echocardiography

Suzuki, Kazuhiro; Hirano, Yutaka; Yamada, Hirotsugu; Murata, Mitsushige; Daimon, Masao; Takeuchi, Masaaki; Seo, Yoshihiro; Izumi, Chisato; Amaki, Makoto

doi:10.1007/s12574-018-0382-8

Cited by 35 publications

(40 citation statements)

References 73 publications

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“…Eine kürzlich publizierte praktische Empfehlung und Bewertung verschiedener Anwendungen der Stressechokardiografie schließt PH-Patienten mit ein [127]. Ungeachtet müssen Bemühungen zur Standardisierung weiter erfolgen, um die bisher noch zu große Interobserver-Variabilität zu optimieren [128,129].…”

Section: Stressechokardiografieunclassified

Aktuelle Definition und Diagnostik der pulmonalen Hypertonie

et al. 2020

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ZusammenfassungDie 6. Weltkonferenz für pulmonale Hypertonie (PH) fand vom 27. 2. – 1. 3. 2018 in Nizza statt. Hier wurden die Erkenntnisse auf dem Gebiet der PH der letzten 5 Jahre nach Aufarbeitung und Diskussion über einen längeren Vorbereitungszeitraum von 13 Arbeitsgruppen präsentiert und in der Folge zum Jahreswechsel 2018/2019 publiziert. Einer der seither intensiv diskutierten Vorschläge ist der einer Änderung der hämodynamischen Definition der PH mit Absenkung des Grenzwertes für den mittleren pulmonalarteriellen Druck von ≥ 25 auf > 20 mmHg, gemessen im Rechtsherzkatheter in Ruhe. Zusätzlich wurde der pulmonalvaskuläre Widerstand in die PH-Definition aufgenommen, was die Wichtigkeit der Bestimmung des Herzzeitvolumens während der Rechtsherzkatheteruntersuchung unterstreicht.Die Rationale sowie mögliche Auswirkungen der neuen PH-Definition, zu welchen zwischenzeitlich bereits neue Publikationen erschienen sind, möchten wir in diesem Übersichtsartikel diskutieren. Ferner ist ein aktueller Überblick zur nicht-invasiven und invasiven Diagnostik der PH enthalten, in welchem auf den Stellenwert der Methoden für Diagnostik, Differenzialdiagnostik und Prognose sowie weitere Neuerungen der 6. PH-Weltkonferenz eingegangen wird. Ergänzt haben wir einen Abschnitt zum Stellenwert von Belastungsuntersuchungen für das Erkennen und die Verlaufsbeurteilung der PH, welche bei der Diskussion in Nizza und in den nachfolgenden Publikationen zumindest erwähnt, aber nicht ausführlicher besprochen wurden.

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Section: Stressechokardiografieunclassified

Aktuelle Definition und Diagnostik der pulmonalen Hypertonie

et al. 2020

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“…They measure myocardial thickness, i.e myocardial thickening in basal conditions and also during pharmacologic interventions. To evaluate the presence or absence of contractile reserve, echocardiography can be monitored throughout pharmacologic intervention ( 8 ). The most validated pharmacologic agent is dobutamine, but some recent reports have used dipyridamole.…”

Section: Discussionmentioning

confidence: 99%

Myocardial viability evaluation using a novel 99mTc SestaMIBI and low dose Dobutamine infusion technique in high risk Ischemic cardiomyopathy patients – A pilot study

Subramanyam¹

2020

Anatol J Cardiol

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Objective: Early identification of viable myocardium in ischemic cardiomyopathy (ICM) patients is essential for early intervention and better clinical outcome. 99m Technetium ( 99m Tc) sestamibi gated myocardial perfusion imaging (gMPI) is a well-established technique for myocardial viability evaluation. Detection of potentially viable segments is a predictor of hibernating myocardium. ICM patients with hibernation have a better prognosis after revascularization. We used a novel infusion technique to determine better viability detection preoperatively in challenging situations. Like thallium, does prolonged availability of sestamibi in circulation with additional low dose dobutamine steady infusion (DS Inf) facilitate improved myocardial viability? Methods: A total of 58 ICM patients with infarct and left ventricular ejection fraction (LVEF) <45% underwent 99m Tc sestamibi bolus injection followed by slow intravenous infusion single-photon emission computed tomography (SPECT) using a 2 day protocol. After acquiring the second set of 99m Tc sestamibi infusion images, a third SPECT gMPI was performed during DS Inf. Results: A 17-segment myocardial model was used; 52 of 58 patients (548/986 segments) demonstrated perfusion defects (nonviable myocardium) on bolus study. Only 24 patients demonstrated viable segments by standard bolus imaging protocol. The slow MIBI infusion study demonstrated 158 viable segments (12 ICM patients), while combined infusion ( 99m Tc sestamibi+DS Inf) exhibited an additional 6 patients with improved myocardial viability. Thus, 18 high risk patients benefited by this novel infusion technique to demonstrate viable myocardium on SPECT. There was a significantly higher sensitivity (p=0.05) and positive predictive value (p=0.01) in viability identification with the combined DS Inf technique. In dysfunctional segments, the rate of concordance for detecting viability between infusion and bolus techniques was 65%. Paired t test showed statistically significant improvement in viability detection with combined infusion compared to the bolus study (p=0.001). Conclusion: This novel infusion technique was shown to be feasible and incremental in viability detection in ICM patients with severe left ventricular dysfunction. It is a robust tool to guide revascularization, in high risk ICM patients. This study also showed that patients with large transmural MI demonstrated no significant improvement in myocardial perfusion status using either protocol.

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“…In addition, ESE was performed using an ergometer in the semi‐supine and left lateral decubitus position (Ergoline 1200 EL; Inter‐Reha Co. Ltd.). The workload was usually started at 25 W and increased by 25 W every 3 min, and echocardiographic images were recorded at rest and at each exercise stage 10 . Of note, we defined a 25 W load exercise for 3 min as low‐load exercise.…”

Section: Methodsmentioning

confidence: 99%

Impact of right ventricular contractile reserve during low‐load exercise on exercise intolerance in heart failure

et al. 2020

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Aims Traditional criteria for heart transplantation by cardiopulmonary exercise testing (CPX) include peak oxygen uptake (VO 2) < 14 mL/kg/min. Reaching a sufficient exercise load is challenging for patients with refractory heart failure (HF) because of their exercise intolerance. Recently, a substantial impact of right ventricular (RV) dysfunction was highlighted on urgent heart transplantation and mortality. This study aims to investigate the impact of RV contractile reserve, assessed by low-load exercise stress echocardiography (ESE), on exercise intolerance defined as peak VO 2 < 14 mL/kg/min, in patients with HF. Methods and results We prospectively examined 67 consecutive patients hospitalized for HF who underwent ESE and CPX under a stabilized HF condition. Although low-load ESE was defined as 25 W load exercise, an increment in RV systolic (s′) velocity was regarded as the preservation of RV contractile reserve. All patients completed low-load ESE. During low-load ESE, the variation in RV s′ velocity significantly correlated with peak VO 2 (r ¼ 0.787, P < 0.001). The change in RV s′ velocity during low-load ESE accurately identified patients with peak VO 2 < 14 mL/kg/min (area under the curve, 0.95; sensitivity, 92%; specificity, 85%). The intraclass correlation coefficient for intra-observer and inter-observer agreement for the change in RV s′ velocity was 0.96 (95% confidence interval, 0.88-0.99, P < 0.001) and 0.86 (95% confidence interval, 0.64-0.95, P < 0.001), respectively. The RV-to-pulmonary circulation (PC) coupling, which was assessed by the slope of the relationship between RV s′ velocity and pulmonary artery systolic pressure at rest and low-load exercise, was worse in the low-peak VO 2 group (<14 mL/kg/min) than the preserved-peak VO 2 group (≥14 mL/kg/min). Conclusions The change in RV s′ velocity during low-load ESE could estimate the exercise capacity in HF patients. The assessments of RV contractile reserve and RV-to-PC coupling could be clinically beneficial to distinguish high-risk HF patients.

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Practical guidance for the implementation of stress echocardiography

Cited by 35 publications

References 73 publications

Aktuelle Definition und Diagnostik der pulmonalen Hypertonie

Aktuelle Definition und Diagnostik der pulmonalen Hypertonie

Myocardial viability evaluation using a novel 99mTc SestaMIBI and low dose Dobutamine infusion technique in high risk Ischemic cardiomyopathy patients – A pilot study

Impact of right ventricular contractile reserve during low‐load exercise on exercise intolerance in heart failure

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