Prognostic value of double product reserve

Rafie, Amir H Sadrzadeh; Sungar, W. Gannon; Dewey, Frederick E.; Hadley, David; Myers, Jonathan; Froelicher, Victor

doi:10.1097/hjr.0b013e328305deef

Cited by 42 publications

(18 citation statements)

References 25 publications

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“…Bouzas-Mosquera et al [20] demonstrated Mark Whitman et al, Downstream cardiac testing following a negative exercise stress test that a substantial increase in SBP alone during exercise testing was associated with a significantly lower risk of mortality and CV events. Individuals achieving greater increases in RPP during exercise have also been shown to have less CV events over time in both those with, and without significant CAD [4,5,21]. The current study confirms this finding, where a significant difference in CV-related events was observed between the two groups from 2 years follow up (p < 0.05; Fig.…”

Section: Discussionsupporting

confidence: 86%

“…Normal values for RPP have been proposed for clinical and nonclinical populations at rest and at maximal exercise [1][2][3]. During EST, RPP has been extensively investigated as a prognostic variable [4][5][6][7]. In a retrospective cohort study of 1759 men, rate pressure product reserve (RPPR) (the difference between RPP at rest and maximal exercise) was the strongest predictor of 7-year cardiovascular (CV) status, even after adjustment for age, beta-blocker use and Duke Treadmill Score [4].…”

Section: Introductionmentioning

confidence: 99%

“…During EST, RPP has been extensively investigated as a prognostic variable [4][5][6][7]. In a retrospective cohort study of 1759 men, rate pressure product reserve (RPPR) (the difference between RPP at rest and maximal exercise) was the strongest predictor of 7-year cardiovascular (CV) status, even after adjustment for age, beta-blocker use and Duke Treadmill Score [4]. In the same study, RPPR was shown to have greater prognostic power than maximum metabolic equivalents (METS), itself a key independent predictor of all-cause and CV mortality [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Is downstream cardiac testing required in patients with reduced functional capacity and otherwise negative exercise stress test? A single center observational study

et al. 2020

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Background: Exercise stress testing (EST) in patients with poor functional capacity measured by time on treadmill is typically deemed inconclusive and usually leads to further downstream testing. The aim of this study was firstly to evaluate the maximum rate pressure product (MRPP) during initial EST to assessthe need for follow-up testing; and secondly to investigate if MRPP is better than age predicted maximum heart rate (APMHR) for diagnostic outcome based on follow up cardiovascular (CV) events in patients with inconclusive EST due to poor functional capacity. Methods: From a total of 2761 tests performed, 236 tests were considered inconclusive due to poor functional capacity which were available for analysis. From receiver operating characteristic (ROC) analysis, a cutoff value for MRPP of 25000 was chosen using CV events as the outcome measure (sensitivity 97%, specificity 45%). Cases were then categorised into those with an MRPP > 25000 and < 25000. Results: Regardless of treadmill time, any patient attaining an MRPP > 25000 had no abnormal downstream testing or CV events at 2 years follow-up. On ROC analysis MRPP outperformed APMHR for sensitivity and specificity (area under curve 0.76 vs. 0.59, respectively). Conclusions: The results suggest that regardless of functional capacity, individuals whose EST is terminated at maximal fatigue, with no electrocardiogram evidence or symptoms of myocardial ischemia and yields an MRPP > 25000, do not require further downstream testing. Furthermore, this group of patients, while not immune to future CV events, have significantly better outcomes than those not attaining a

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Is downstream cardiac testing required in patients with reduced functional capacity and otherwise negative exercise stress test? A single center observational study

et al. 2020

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“…Blood pressure was then averaged into hourly blood pressures. As a surrogate measure of myocardial oxygen consumption, 16 the RPP was calculated from the mean hourly HRs and the mean hourly systolic blood pressures: RPP = HR × SBP.…”

Section: Animals Materials and Methodsmentioning

confidence: 99%

Pharmacodynamic effects of ivabradine, a negative chronotropic agent, in healthy cats

Cober

Schober

Buffington

et al. 2011

Journal of Veterinary Cardiology

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Objective To determine the pharmacodynamic effects of oral ivabradine in cats. Animals Eight healthy, adult domestic short hair cats. Methods Each cat underwent four study periods of 24 h, receiving either one dose of placebo or ivabradine (0.1 mg/kg, 0.3 mg/kg, and 0.5 mg/kg) in a single-blind randomized crossover study. Clinical tolerance was assessed hourly for the first 8 h, at 12 h, and at the end of the 24-h study period. Heart rate and blood pressure were monitored continuously for 18–24 h via radiotelemetry after each treatment. Response to stress (acoustic startle) was studied before (t = 0) and after treatment (t = 4 h). Statistical comparisons were made using a linear mixed models and 1-way and 2-way repeated measures ANOVA. Results Heart rate (min−1) decreased significantly (P < 0.05) in a dose-dependent manner with peak negative chronotropic effects observed 3 h after ivabradine (mean ±SD; placebo, 144 ± 20; ivabradine 0.1 mg/kg, 133 ±22; ivabradine 0.3 mg/kg, 112 ±20; and ivabradine 0.5 mg/kg, 104 ±11). Heart rate (min−1) was still reduced (P < 0.05) 12 h after ivabradine (0.3 mg/kg; 128 ±18 and 0.5 mg/kg; 124 ±16) compared to placebo (141 ±21). The tachycardic response to acoustic startle was significantly (P < 0.01) blunted at all 3 doses of ivabradine. Myocardial oxygen consumption estimated by the rate-pressure product was significantly reduced (P < 0.05) for all doses of ivabradine. No effect of ivabradine on systolic, diastolic, and mean blood pressure was identified and no clinically discernable side effects were observed. Conclusion These findings indicate that a single oral dose of ivabradine predictably lowers heart rate, blunts the chronotropic response to stress, and is clinically well tolerated in healthy cats. This makes ivabradine potentially interesting in the treatment of feline heart disease where ischemia is of pathophysiologic importance.

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“…In critically ill patients, many CCR-related parameters (oxygen consumption, stroke work, cardiac power …) have been studied, most of which are derived from cardiac index (CI) magnitude during a dobutamine test [6]. Double product (systolic arterial pressure × heart rate) is an old hemodynamic tool, closely related to CR and known to have low values in chronic heart failure [7–9]. Its evolutive pattern has never been established during shock states.…”

Section: Introductionmentioning

confidence: 99%

Cardiac Contractile Reserve Parameters Are Related to Prognosis in Septic Shock

Kimmoun

Ducrocq

Mory

et al. 2013

BioMed Research International

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Introduction. Cardiac reserve could be defined as the spontaneous magnitude from basal to maximal cardiac power under stress conditions. The aim of this study was to evaluate the prognostic value of cardiac reserve parameters in resuscitated septic shock patients. Methods. Seventy patients with septic shock were included in a prospective and observational study. Prior to inclusion, patients were resuscitated to reach a mean arterial pressure of 65–75 mmHg with an euvolemic status. General, hemodynamic, and cardiac reserve-related parameters (cardiac index, double product, and cardiac power index) were collected at inclusion and at day 1. Results. Seventy patients were included with 28-day mortality at 38.5%. Ten of the 70 patients died during the first day. In multivariate analysis, independent predictors of death were SAPS II ≥58 (OR: 3.36 [1.11–10.17]; P = 0.032), a high double product at inclusion (OR [95% IC]: 1.20 [1.00–1.45] per 103 mmHg·min; P = 0.047), and at day 1, a decrease in cardiac index (1.30 [1.08–1.56] per 0.5 L/min/m2; P = 0.007) or cardiac power index (1.84 [1.18–2.87] per 0.1 W/m2, P = 0.008). Conclusion. In the first 24 hours, parameters related to cardiac reserve, such as double product and cardiac index evolution, provide crucial and easy to achieve hemodynamic physiological information, which may impact the outcome.

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Prognostic value of double product reserve

Abstract: In this study population, DP reserve had greater prognostic power than metabolic equivalents, maximal HR or systolic blood pressure, or HR recovery.

Cited by 42 publications

References 25 publications

Is downstream cardiac testing required in patients with reduced functional capacity and otherwise negative exercise stress test? A single center observational study

Is downstream cardiac testing required in patients with reduced functional capacity and otherwise negative exercise stress test? A single center observational study

Pharmacodynamic effects of ivabradine, a negative chronotropic agent, in healthy cats

Cardiac Contractile Reserve Parameters Are Related to Prognosis in Septic Shock

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