Use of end‐systolic volume changes with exercise to detect left ventricular dysfunction in patients with coronary artery disease

Greenberg, Paul S.; Berge, R. D.; Johnson, Kenneth D.; Bible, Monte; Ellestad, Myrvin H.; Hayes, M.; Messenger, John C.

doi:10.1002/clc.4960050704

Cited by 3 publications

(1 citation statement)

References 13 publications

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“…CO at stress was similar to other studies of healthy individuals, where 15-20 L min −1 was reached at maximal exercise (Turley andWilmore 1997, Bromley et al 2006). LVESV was significantly ( p < 0.01) decreased following maximal exercise stress, as expected (Upton et al 1980, Greenberg et al 1982, Iskandrian et al 1983, Stratton et al 1994. The positive correlation we observed between post-exercise SV and VO .…”

Section: Discussionsupporting

confidence: 85%

Cardiopulmonary exercise testing in the MRI environment

et al. 2016

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Maximal oxygen consumption ([Formula: see text]max) measured by cardiopulmonary exercise testing (CPX) is the gold standard for assessment of cardiorespiratory fitness. Likewise, cardiovascular magnetic resonance (CMR) is the gold standard for quantification of cardiac function. The combination of CPX and CMR may offer unique insights into cardiopulmonary pathophysiology; however, the MRI-compatible equipment needed to combine these tests has not been available to date. We sought to determine whether CPX testing in the MRI environment, using equipment modified for MRI yields results equivalent to those obtained in standard exercise physiology (EP) lab. Ten recreationally trained subjects completed [Formula: see text]max tests in different locations; an EP laboratory and an MRI laboratory, using site specific equipment. CMR cine images of the heart were acquired before and immediately after maximal exercise to measure cardiac function. Subjects in all tests met criteria indicating that peak exercise was achieved. Despite equipment modifications for the MRI environment, [Formula: see text]max was nearly identical between tests run in the different labs (95% lower confidence limit (LCL) = 0.8182). The mean difference in [Formula: see text]max was less than 3.40 ml (kg/min)(-1), within the variability expected for tests performed on different days, in different locations, using different metabolic carts. MRI performed at rest and following peak exercise stress indicated cardiac output increased from 5.1 ± 1.0 l min(-1) to 16.4 ± 5.6 l min(-1), LVEF increased from 65.2 ± 3.3% to 78.4 ± 4.8%, while RVEF increased from 52.8 ± 5.3% to 63.4 ± 5.3%. Regression analysis revealed a significant positive correlation between [Formula: see text]max and stroke volume (R = 0.788, P = 0.006), while the correlation with cardiac output did not reach statistical significance (R = 0.505, P = 0.137). [Formula: see text]max CPX testing can be effectively performed in the MRI environment, enabling direct combination of physiological data with advanced post-exercise imaging in the same test session.

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Section: Discussionsupporting

confidence: 85%

Cardiopulmonary exercise testing in the MRI environment

et al. 2016

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Prognostic Value of Left Ventricular End-Systolic Volume Index as a Predictor of Heart Failure Hospitalization in Stable Coronary Artery Disease: Data from the Heart and Soul Study

McManus¹,

Shah²,

Fabi³

et al. 2009

Journal of the American Society of Echocardiography

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Objective-Left ventricular (LV) end-systolic volume indexed to body surface area (ESVI) is a simple yet powerful echocardiographic marker of LV remodeling that can be measured easily. The prognostic value of ESVI and its merit relative to other markers of LV remodeling in patients with coronary heart disease are unknown.Methods-We examined the association of ESVI with hospitalization for heart failure (HF) and mortality in a prospective study of patients with coronary heart disease.Results-Of the 989 participants, 110 (11%) were hospitalized for HF during 3.6 ± 1.1 years of follow-up. Among participants in the highest ESVI quartile (>25 mL/m 2 ), 67 of 248 (27%) developed HF compared with 8 of 248 (3%) among those in the lowest quartile. The association between ESVI and HF hospitalization persisted after adjustment for potential confounders (hazard ratio 5.0, 95% confidence interval, 1.5-16.9; P = .01).Conclusion-ESVI >25 mL/m 2 is an independent predictor of hospitalization for HF in patients with stable coronary heart disease. KeywordsCoronary artery disease; End-systolic volume index; Heart failure hospitalization; Left ventricular remodeling Coronary heart disease (CHD) is the strongest risk factor for heart failure (HF), and when CHD coexists with HF, patients have increased morbidity and mortality compared with those with either disease alone. 1-4 Therefore, early identification of patients with CHD who are at increased risk for HF is of great importance because it might enable earlier treatment, allow for closer monitoring, and potentially reduce considerable morbidity and mortality.Left ventricular (LV) end-systolic volume (ESV) has been shown to be an important determinant of survival after myocardial infarction (MI). 5,6 A decrease in ESV with angiotensin-converting enzyme inhibitor therapy has been associated with a reduction in cardiac events in patients with moderately decreased LV systolic function. 7 By using left ventriculography, ESV has been shown to be an important predictor of both postoperative LV function and survival after coronary artery bypass grafting in patients with LV systolic dysfunction. 8,9 The aforementioned studies have consistently shown that large increases in ESV predict adverse cardiovascular outcomes in participants with LV systolic dysfunction. NIH Public AccessWith advances in the treatment of CHD, most patients are living longer, and the number of patients at risk of and dying of HF continues to grow. 2,4,10 Current HF guidelines 11 emphasize early identification of patients who are at risk for morbidity and mortality from HF, which is important not only for the prevention of HF and early initiation of therapies for HF but also for the containment of health care costs associated with treating those with advanced HF. Echocardiography has become one of the most commonly used noninvasive modalities for assessment of ventricular volumes and function, 12 and can provide prognostic information for the prediction of future HF events. 13 Although many sophisticated echo...

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Increase in end-systolic volume after exercise independently predicts mortality in patients with coronary heart disease: data from the Heart and Soul Study

Turakhia

McManus²,

Whooley

et al. 2009

European Heart Journal

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End-systolic volume reversal is a novel parameter that independently predicts mortality in patients with CHD undergoing exercise treadmill echocardiography, even after adjustment for a wide range of clinical, echocardiographic, and treadmill exercise variables. Because measurement of ESV is simple, reproducible, and requires no additional imaging views, identification of ESV reversal during exercise echocardiography can provide useful complementary information for risk stratification.

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Use of end‐systolic volume changes with exercise to detect left ventricular dysfunction in patients with coronary artery disease

Cited by 3 publications

References 13 publications

Cardiopulmonary exercise testing in the MRI environment

Cardiopulmonary exercise testing in the MRI environment

Prognostic Value of Left Ventricular End-Systolic Volume Index as a Predictor of Heart Failure Hospitalization in Stable Coronary Artery Disease: Data from the Heart and Soul Study

Increase in end-systolic volume after exercise independently predicts mortality in patients with coronary heart disease: data from the Heart and Soul Study

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