Treadmill Exercise Echocardiography as a Predictor of Events in Patients With Left Ventricular Hypertrophy

Peteiro, Jesús; Bouzas‐Mosquera, Alberto; Broullón, Francisco J.; Pazos, Pablo; Estévez‐Loureiro, Rodrigo; Castro‐Beiras, Alfonso

doi:10.1038/ajh.2010.68

Cited by 7 publications

(5 citation statements)

References 34 publications

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“…In patients with left ventricular hypertrophy undergoing exercise echocardiography, left ventricular mass index predicted mortality, and failure to increase ejection fraction with exercise predicted cardiovascular death and nonfatal myocardial infarction [29]. A study in patients with left ventricular hypertrophy found that ischemic changes at peak exercise predicted overall mortality and major cardiac events [30]. Finally, a study evaluating the effects of left ventricular geometry on exercise capacity found that patients with concentric hypertrophy demonstrated less exercise capacity and attenuated hemodynamic responses to exercise compared with patients with eccentric hypertrophy [31].…”

Section: Key Pointsmentioning

confidence: 99%

Recent advances in stress echocardiography

Cullen¹,

Pellikka²

2011

Current Opinion in Cardiology

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Dobutamine stress echocardiography (DSE) is a reliable cardiac risk stratifier that has widespread applicability because of its clinical accuracy and cost effectiveness. Dobut-amine has positive inotropic and chronotropic effects and is commonly used in patients who cannot exercise or achieve an adequate heart rate response with exercise. Recently available long-term results from several independent clinical trials, combined with enhancements in image quality, have improved the ability to detect significant coronary artery disease and determine myocardial viability. Dobutamine stress echocardiog-raphy has an excellent safety profile with clinical results superior to regular exercise electrocardiography and comparable with exercise echocardiography and radionucleotide perfusion stress imaging. Low-dose dobutamine response can accurately predict dysfunctional yet viable myocardial regions that may improve with revascularization. Clinical studies are now available refining the common use of DSE preoperatively in female patients with valvular disease, as well as in the emergency department. Dobutamine stress echocardiography does have some limitations in discriminating particular regions of ischemia when multiple ventricular segments are involved and when the imaging is suboptimal. It can be applied using minimal additional resources in an otherwise functioning echocar-diography laboratory and, with appropriate training, can result in clinical results comparable with those of large-scale multi-center trials. Ongoing improvements in technology and the development of new reagents such as myocardial contrast agents hold promise for further advancement in the near future.

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Section: Key Pointsmentioning

confidence: 99%

Recent advances in stress echocardiography

Cullen¹,

Pellikka²

2011

Current Opinion in Cardiology

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“…There is wide information regarding the incremental diagnostic and prognostic value of stress echocardiography over clinical characteristics, resting echocardiography and exercise testing in different populations and scenarios, particularly for patients with already demonstrated CAD, intermediate pre-test probability of CAD, and/or resting ECG abnormalities [19][20][21][22][23][24][25]. In patients with right bundle branch block, the number of interpretable leads is sometimes limited.…”

Section: Stress Echocardiography In Different Populationsmentioning

confidence: 99%

Novelties on Stress Echocardiography for the Assessment of Ischemia

Peteiro¹

2017

Int Arch Intern Med

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“…In patients with known or clinically suspected left ventricular hypertrophy, exercise echocardiography has been shown to be more accurate than exercise ECG testing for the detection of CAD 27 and to provide incremental prognostic information in the prediction of death and other major adverse cardiac events. 24,25 Moreover, the anginal symptoms in patients with left ventricular hypertrophy may in part be related to coronary microvascular dysfunction and are not always easy to discern from dyspnoea caused by an associated left ventricular diastolic dysfunction. Transthoracic Doppler may allow the assessment of coronary flow velocity reserve at rest 28 and to monitor changes of pulmonary pressure changes and diastolic left ventricular function parameters 29 during exercise that may increase significantly in patients with an underlying concealed left ventricular diastolic dysfunction.…”

Section: Jm Vrintsmentioning

confidence: 99%

“…Furthermore, patients with left ventricular hypertrophy constitute a high-risk subgroup with an almost three times increased risk of cardiovascular morbidity and mortality. [24][25][26] Therefore, refined analysis of exercise ECG should be combined with exercise echocardiography in order to increase the diagnostic accuracy and the prognostic predictive power in this subset of patients. In patients with known or clinically suspected left ventricular hypertrophy, exercise echocardiography has been shown to be more accurate than exercise ECG testing for the detection of CAD 27 and to provide incremental prognostic information in the prediction of death and other major adverse cardiac events.…”

Section: Jm Vrintsmentioning

confidence: 99%

Refined interpretation of exercise ECG testing: Opportunities for a comeback in the era of expanding advanced cardiac imaging technologies?

Vrints

2016

Eur J Prev Cardiolog

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Ever since the initial description of the Master step test in 1942 1 exercise electrocardiography (ECG) is the most widely used non-invasive method for the diagnosis of angina pectoris and the risk stratification of patients with known coronary artery disease (CAD). Its diagnostic accuracy in detecting significantly obstructive CAD based on the development of 'ischaemic' horizontal or down-sloping ST-segment depressions during exercise is, however, rather mediocre, with a sensitivity of 68% and a specificity of 77%.2 When tested in populations without referral bias from coronary angiography the sensitivity dropped to 50% whereas the specificity increased to 90%.3 However, the diagnostic and prognostic value of exercise ECG testing can be enhanced by incorporating in the assessment additional clinical data that exercise testing provides beyond the detection of ST-segment depression: exercise capacity, chronotropic and blood pressure response, heart rate recovery, calculation of the Duke treadmill score, T-wave alternans. [4][5][6][7] The diagnostic accuracy of exercise ECG can further be improved by analysis of the relation between ST-segment depression and heart rate changes during exercise and recovery.8 Heart rate adjustment of ST-segment depression during exercise performed by calculating the ST-segment/heart rate (ST/HR) slope or the ST/HR index can improve the sensitivity with preservation of specificity, mainly from improved classification of patients with equivocal test responses related to up-sloping ST-segments.9 Analysis of the ST/HR loop during exercise and early recovery for the presence of hysteresis provides an alternative method for determining exercise ECG test positivity and negativity. ST-segment depression caused by myocardial ischaemia resolves in patients more slowly during the early recovery phase than in normal individuals. This leads to the presence of a positive ST/HR hysteresis in ischaemic patients as the ST-depression during the first few minutes is greater than it was at the same heart rate during exercise, whereas normal individuals show a negative ST/HR hysteresis ( Figure 1). Analysis of post-exercise ST/HR hysteresis has been shown to provide higher diagnostic and prognostic test accuracy than that found for the standard ST-segment depression criteria and other ST/HR indices. 10,11Exercise ECG has a much lower specificity in patients with left ventricular hypertrophy in whom false positive tests are frequently observed.13-15 The present study by Zimarino et al. shows an enhanced diagnostic accuracy of ST/HR hysteresis in patients with hypertension-related left ventricular hypertrophy and confirms the very low specificity of the classic maximal ST-segment depression criterion that is clinically largely unreliable in detecting significant CAD in those patients. 16 The authors call for the adoption of the ST/HR hysteresis analysis in the interpretation of exercise testing in patients with left ventricular hypertrophy in order to limit the need for additional functional imaging tests...

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Treadmill Exercise Echocardiography as a Predictor of Events in Patients With Left Ventricular Hypertrophy

Abstract: LV mass independently predicts mortality, even when EE data are considered. EE provides significant information for predicting events in patients with LVH and known/suspected CAD.

Cited by 7 publications

References 34 publications

Recent advances in stress echocardiography

Recent advances in stress echocardiography

Novelties on Stress Echocardiography for the Assessment of Ischemia

Refined interpretation of exercise ECG testing: Opportunities for a comeback in the era of expanding advanced cardiac imaging technologies?

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