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Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study

AIMS: The purpose of this pilot study was to assess the potential usefulness of diastolic stress test (DST) echocardiography in patients with suspected heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: Patients with suspected HFpEF (left ventricular ejection fraction ≥ 50%...

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Autores principales: Belyavskiy, Evgeny, Morris, Daniel A., Url‐Michitsch, Marion, Verheyen, Nicolas, Meinitzer, Andreas, Radhakrishnan, Aravind‐Kumar, Kropf, Martin, Frydas, Athanasios, Ovchinnikov, Artem G., Schmidt, Albrecht, Tadic, Marijana, Genger, Martin, Lindhorst, Ruhdja, Bobenko, Anna, Tschöpe, Carsten, Edelmann, Frank, Pieske‐Kraigher, Elisabeth, Pieske, Burkert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352885/
https://www.ncbi.nlm.nih.gov/pubmed/30451399
http://dx.doi.org/10.1002/ehf2.12375
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author Belyavskiy, Evgeny
Morris, Daniel A.
Url‐Michitsch, Marion
Verheyen, Nicolas
Meinitzer, Andreas
Radhakrishnan, Aravind‐Kumar
Kropf, Martin
Frydas, Athanasios
Ovchinnikov, Artem G.
Schmidt, Albrecht
Tadic, Marijana
Genger, Martin
Lindhorst, Ruhdja
Bobenko, Anna
Tschöpe, Carsten
Edelmann, Frank
Pieske‐Kraigher, Elisabeth
Pieske, Burkert
author_facet Belyavskiy, Evgeny
Morris, Daniel A.
Url‐Michitsch, Marion
Verheyen, Nicolas
Meinitzer, Andreas
Radhakrishnan, Aravind‐Kumar
Kropf, Martin
Frydas, Athanasios
Ovchinnikov, Artem G.
Schmidt, Albrecht
Tadic, Marijana
Genger, Martin
Lindhorst, Ruhdja
Bobenko, Anna
Tschöpe, Carsten
Edelmann, Frank
Pieske‐Kraigher, Elisabeth
Pieske, Burkert
author_sort Belyavskiy, Evgeny
collection PubMed
description AIMS: The purpose of this pilot study was to assess the potential usefulness of diastolic stress test (DST) echocardiography in patients with suspected heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: Patients with suspected HFpEF (left ventricular ejection fraction ≥ 50%, exertional dyspnoea, septal E/e′ at rest 9–14, and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) at rest < 220 pg/mL; n = 13) and a control group constituted from asymptomatic patients with arterial hypertension (n = 19) and healthy subjects (n = 18) were included. All patients were analysed by two‐dimensional and Doppler echocardiography at rest and during exercise (DST) and underwent cardiopulmonary exercise testing and NT‐proBNP analysis during exercise. HFpEF during exercise was defined as exertional dyspnoea and peak VO(2) ≤ 20.0 mL/min/kg. In patients with suspected HFpEF at rest, 84.6% of these patients developed HFpEF during exercise, whereas in the group of asymptomatic patients with hypertension and healthy subjects, the rate of developed HFpEF during exercise was 0%. Regarding the diagnostic performance of DST to detect HFpEF during exercise, an E/e′ ratio >15 during exercise was the most accurate parameter to detect HFpEF (accuracy 86%), albeit a low sensitivity (45.5%). Nonetheless, combining E/e′ with tricuspid regurgitation (TR) velocity > 2.8 m/s during exercise provided a significant increase in the sensitivity to detect patients with HFpEF during exercise (sensitivity 72.7%, specificity 79.5%, and accuracy 78%). Consistent with these findings, an increase of E/e′ was significantly linked to worse peak VO(2), and the combination of an increase of both E/e′ and TR velocity was associated with elevated NT‐proBNP values during exercise. CONCLUSIONS: The findings of this pilot study suggest that DST using E/e′ ratio and TR velocity could be of potential usefulness to diagnose HFpEF during exercise in patients with suspected HFpEF at rest.
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spelling pubmed-63528852019-02-06 Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study Belyavskiy, Evgeny Morris, Daniel A. Url‐Michitsch, Marion Verheyen, Nicolas Meinitzer, Andreas Radhakrishnan, Aravind‐Kumar Kropf, Martin Frydas, Athanasios Ovchinnikov, Artem G. Schmidt, Albrecht Tadic, Marijana Genger, Martin Lindhorst, Ruhdja Bobenko, Anna Tschöpe, Carsten Edelmann, Frank Pieske‐Kraigher, Elisabeth Pieske, Burkert ESC Heart Fail Original Research Articles AIMS: The purpose of this pilot study was to assess the potential usefulness of diastolic stress test (DST) echocardiography in patients with suspected heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: Patients with suspected HFpEF (left ventricular ejection fraction ≥ 50%, exertional dyspnoea, septal E/e′ at rest 9–14, and N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) at rest < 220 pg/mL; n = 13) and a control group constituted from asymptomatic patients with arterial hypertension (n = 19) and healthy subjects (n = 18) were included. All patients were analysed by two‐dimensional and Doppler echocardiography at rest and during exercise (DST) and underwent cardiopulmonary exercise testing and NT‐proBNP analysis during exercise. HFpEF during exercise was defined as exertional dyspnoea and peak VO(2) ≤ 20.0 mL/min/kg. In patients with suspected HFpEF at rest, 84.6% of these patients developed HFpEF during exercise, whereas in the group of asymptomatic patients with hypertension and healthy subjects, the rate of developed HFpEF during exercise was 0%. Regarding the diagnostic performance of DST to detect HFpEF during exercise, an E/e′ ratio >15 during exercise was the most accurate parameter to detect HFpEF (accuracy 86%), albeit a low sensitivity (45.5%). Nonetheless, combining E/e′ with tricuspid regurgitation (TR) velocity > 2.8 m/s during exercise provided a significant increase in the sensitivity to detect patients with HFpEF during exercise (sensitivity 72.7%, specificity 79.5%, and accuracy 78%). Consistent with these findings, an increase of E/e′ was significantly linked to worse peak VO(2), and the combination of an increase of both E/e′ and TR velocity was associated with elevated NT‐proBNP values during exercise. CONCLUSIONS: The findings of this pilot study suggest that DST using E/e′ ratio and TR velocity could be of potential usefulness to diagnose HFpEF during exercise in patients with suspected HFpEF at rest. John Wiley and Sons Inc. 2018-11-19 /pmc/articles/PMC6352885/ /pubmed/30451399 http://dx.doi.org/10.1002/ehf2.12375 Text en © 2018 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research Articles
Belyavskiy, Evgeny
Morris, Daniel A.
Url‐Michitsch, Marion
Verheyen, Nicolas
Meinitzer, Andreas
Radhakrishnan, Aravind‐Kumar
Kropf, Martin
Frydas, Athanasios
Ovchinnikov, Artem G.
Schmidt, Albrecht
Tadic, Marijana
Genger, Martin
Lindhorst, Ruhdja
Bobenko, Anna
Tschöpe, Carsten
Edelmann, Frank
Pieske‐Kraigher, Elisabeth
Pieske, Burkert
Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study
title Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study
title_full Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study
title_fullStr Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study
title_full_unstemmed Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study
title_short Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study
title_sort diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6352885/
https://www.ncbi.nlm.nih.gov/pubmed/30451399
http://dx.doi.org/10.1002/ehf2.12375
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