The Prognostic Value of the Diastolic Stress Test in Patients Undergoing Treadmill Stress Echocardiography

Fitzgerald, B.; Presneill, Jeffrey; Scalia, I.; Hawkins, C.; Celermajer, Y.; Scalia, W.; Scalia, G.

doi:10.1016/j.echo.2019.05.021

Cited by 25 publications

(25 citation statements)

References 23 publications

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“…1,2 Additional parameters can be utilised to assist with this difficult interpretation, including strain and strain rate, 16,17 and assessments of diastolic function. 1,18 None of these have become routine practice.…”

Section: Discussionmentioning

confidence: 99%

“…(see Materials and Methods). 7,11,18,26,27 The changes in SV and measures of diastolic function have been shown to be reliable when compared to invasive techniques. 18,[28][29][30][31] Changes in Doppler echocardiography have been documented in the setting of CAD.…”

Section: Discussionmentioning

confidence: 99%

“…7,11,18,26,27 The changes in SV and measures of diastolic function have been shown to be reliable when compared to invasive techniques. 18,[28][29][30][31] Changes in Doppler echocardiography have been documented in the setting of CAD. [32][33][34] These concepts contributed to the hypothesis that SV could be a simple and readily measurable parameter to assist with analysis for stress echocardiography.…”

Section: Discussionmentioning

confidence: 99%

“…It adds only seconds to the resting echocardiogram and to the post exercise analysis and can be done after regional wall analysis but before the estimations of diastolic function. 18 The proposed cut-off appears to apply for the detection of ischemia and for the detection of adverse cardiac events.…”

Section: Discussionmentioning

confidence: 99%

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The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

Fitzgerald

Logan

Weldon

et al. 2020

Preprint

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Background: Stress echocardiography (SE) is an established technique for assessment of coronary artery disease (CAD) which is difficult to perform and interpret. Left ventricular stroke volume (SV) is readily estimated with Doppler echocardiography. It can be affected by myocardial ischemia, with possible adjunctive value during SE. Methods: Patients underwent Bruce protocol SE with SV estimated before and after maximal treadmill exertion post routine regional wall analysis. Incremental change in SV (ΔSV) with exercise was measured. Results: A derivation cohort (n=273) was established to test the hypothesis. An optimal cutoff for detection on inducible ischemia was ΔSV [?] +10ml. The validation cohort of consecutive patients (n = 1093, 376 [34%] female; age 59±12 years) were followed clinically after SE for 20,460 patient-months. There were 1000 patients with non-ischemic SE, and 93 patients with studies suggestive of myocardial ischemia. Secondary analysis yielded 831 patients with a normal exercise response (ΔSV > +10ml) and 192 with an abnormal ΔSV [?] +10ml. Time to first combined adverse cardiac event (composite of angina, acute coronary syndrome, cardiac revascularization, worsening New York Heart Association (NYHA) class, a reduction in EF, and cardiovascular death) was analysed and adjusted using Cox proportional hazards regression. The hazard ratio for an adverse event with an abnormal ΔSV response ([?]10ml) was 10.3 (95% confidence intervals 5.6-19.1, p<0.0001). Conclusions: SV assessment during SE is feasible and readily performed. It is simple, practical and has incremental diagnostic and prognostic value when added to exercise regional wall motion analysis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

Fitzgerald

Logan

Weldon

et al. 2020

Preprint

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“…The final 8 studies included 4462 patients with a follow-up duration ranging from 13 months to 5 years. [12][13][14][15][16][17][18][19] The baseline demographic and clinical characteristics of the study participants are summarized in Table 2. A majority of studies reported exercise-induced DD based on E/e′ ratio except for Takagi et al which reported E/A ratio.…”

Section: Re Sultsmentioning

confidence: 99%

Prognostic significance of exercise‐induced diastolic dysfunction: A systematic review

Sud¹,

Bhatia²,

Vogel³

et al. 2020

Echocardiography

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Background: Recent guidelines recommend diastolic stress testing among patients with unexplained dyspnea. Previous studies have reported exercise related change in diastolic parameters as a prognostic marker for worse outcomes. However, the role of exercise-induced diastolic dysfunction (DD) in predicting adverse outcomes has not been fully established. Method: We conducted a meta-analysis to explore the prognostic significance of exercise-induced DD. PUBMED/EMBASE/SCOPUS databases were searched for studies reporting adverse outcomes in patients undergoing exercise echocardiography based on diastolic response during exercise. Exercise-induced DD was defined as an increase in E/e′ or E/A ratio with stress. Outcomes of interest were cardiovascular mortality or hospitalizations. Results: A total of 8 studies were identified, including 4,462 patients who underwent exercise stress echocardiography. The follow-up ranged from 13 months to 5 years. The major indication for stress testing was exertional dyspnea. All studies reported cardiac mortality and hospitalization in the composite outcome. Meta-analysis conducted using random-effects model showed that exercise-induced DD was associated with a higher likelihood of cardiovascular mortality or hospitalization (HR = 1.32, P < .05). Significant heterogeneity was noted among the studies. Conclusions: Exercise-induced DD is associated with worse cardiovascular outcomes. Changes in echocardiographic parameters such as e′ with exercise might be useful for risk stratification and identification of high-risk patients.

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Clinical relevance of spectral tissue Doppler-derived E/e′ in older patients with preserved ejection fraction

Arquès

Chelaifa

Vieillard

et al. 2021

Annales de Cardiologie et d'Angéiologie

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The Prognostic Value of the Diastolic Stress Test in Patients Undergoing Treadmill Stress Echocardiography

Cited by 25 publications

References 23 publications

The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

The prognostic value of estimating stroke volume before and after exercise during treadmill stress echocardiography

Prognostic significance of exercise‐induced diastolic dysfunction: A systematic review

Clinical relevance of spectral tissue Doppler-derived E/e′ in older patients with preserved ejection fraction

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