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author Bombardini, Tonino
Zagatina, Angela
Ciampi, Quirino
Arbucci, Rosina
Merlo, Pablo Martin
Haber, Diego M. Lowenstein
Morrone, Doralisa
D’Andrea, Antonello
Djordjevic-Dikic, Ana
Beleslin, Branko
Tesic, Milorad
Boskovic, Nikola
Giga, Vojislav
de Castro e Silva Pretto, José Luis
Daros, Clarissa Borguezan
Amor, Miguel
Mosto, Hugo
Salamè, Michael
Monte, Ines
Citro, Rodolfo
Simova, Iana
Samardjieva, Martina
Wierzbowska-Drabik, Karina
Kasprzak, Jaroslaw D.
Gaibazzi, Nicola
Cortigiani, Lauro
Scali, Maria Chiara
Pepi, Mauro
Antonini-Canterin, Francesco
Torres, Marco A. R.
Nes, Michele De
Ostojic, Miodrag
Carpeggiani, Clara
Kovačević-Preradović, Tamara
Lowenstein, Jorge
Arruda-Olson, Adelaide M.
Pellikka, Patricia A.
Picano, Eugenio
author_facet Bombardini, Tonino
Zagatina, Angela
Ciampi, Quirino
Arbucci, Rosina
Merlo, Pablo Martin
Haber, Diego M. Lowenstein
Morrone, Doralisa
D’Andrea, Antonello
Djordjevic-Dikic, Ana
Beleslin, Branko
Tesic, Milorad
Boskovic, Nikola
Giga, Vojislav
de Castro e Silva Pretto, José Luis
Daros, Clarissa Borguezan
Amor, Miguel
Mosto, Hugo
Salamè, Michael
Monte, Ines
Citro, Rodolfo
Simova, Iana
Samardjieva, Martina
Wierzbowska-Drabik, Karina
Kasprzak, Jaroslaw D.
Gaibazzi, Nicola
Cortigiani, Lauro
Scali, Maria Chiara
Pepi, Mauro
Antonini-Canterin, Francesco
Torres, Marco A. R.
Nes, Michele De
Ostojic, Miodrag
Carpeggiani, Clara
Kovačević-Preradović, Tamara
Lowenstein, Jorge
Arruda-Olson, Adelaide M.
Pellikka, Patricia A.
Picano, Eugenio
author_sort Bombardini, Tonino
collection PubMed
description Background: Two-dimensional volumetric exercise stress echocardiography (ESE) provides an integrated view of left ventricular (LV) preload reserve through end-diastolic volume (EDV) and LV contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose: To assess the dependence of cardiac reserve upon LVCR, EDV, and heart rate (HR) during ESE. Methods: We prospectively performed semi-supine bicycle or treadmill ESE in 1344 patients (age 59.8 ± 11.4 years; ejection fraction = 63 ± 8%) referred for known or suspected coronary artery disease. All patients had negative ESE by wall motion criteria. EDV and ESV were measured by biplane Simpson rule with 2-dimensional echocardiography. Cardiac index reserve was identified by peak-rest value. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values ≤2.0). Preload reserve was defined by an increase in EDV. Cardiac index was calculated as stroke volume index * HR (by EKG). HR reserve (stress/rest ratio) <1.85 identified chronotropic incompetence. Results: Of the 1344 patients, 448 were in the lowest tertile of cardiac index reserve with stress. Of them, 303 (67.6%) achieved HR reserve <1.85; 252 (56.3%) had an abnormal LVCR and 341 (76.1%) a reduction of preload reserve, with 446 patients (99.6%) showing ≥1 abnormality. At binary logistic regression analysis, reduced preload reserve (odds ratio [OR]: 5.610; 95% confidence intervals [CI]: 4.025 to 7.821), chronotropic incompetence (OR: 3.923, 95% CI: 2.915 to 5.279), and abnormal LVCR (OR: 1.579; 95% CI: 1.105 to 2.259) were independently associated with lowest tertile of cardiac index reserve at peak stress. Conclusions: Heart rate assessment and volumetric echocardiography during ESE identify the heterogeneity of hemodynamic phenotypes of impaired chronotropic, preload or LVCR underlying a reduced cardiac reserve.
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spelling pubmed-82676482021-07-10 Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography Bombardini, Tonino Zagatina, Angela Ciampi, Quirino Arbucci, Rosina Merlo, Pablo Martin Haber, Diego M. Lowenstein Morrone, Doralisa D’Andrea, Antonello Djordjevic-Dikic, Ana Beleslin, Branko Tesic, Milorad Boskovic, Nikola Giga, Vojislav de Castro e Silva Pretto, José Luis Daros, Clarissa Borguezan Amor, Miguel Mosto, Hugo Salamè, Michael Monte, Ines Citro, Rodolfo Simova, Iana Samardjieva, Martina Wierzbowska-Drabik, Karina Kasprzak, Jaroslaw D. Gaibazzi, Nicola Cortigiani, Lauro Scali, Maria Chiara Pepi, Mauro Antonini-Canterin, Francesco Torres, Marco A. R. Nes, Michele De Ostojic, Miodrag Carpeggiani, Clara Kovačević-Preradović, Tamara Lowenstein, Jorge Arruda-Olson, Adelaide M. Pellikka, Patricia A. Picano, Eugenio J Clin Med Article Background: Two-dimensional volumetric exercise stress echocardiography (ESE) provides an integrated view of left ventricular (LV) preload reserve through end-diastolic volume (EDV) and LV contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose: To assess the dependence of cardiac reserve upon LVCR, EDV, and heart rate (HR) during ESE. Methods: We prospectively performed semi-supine bicycle or treadmill ESE in 1344 patients (age 59.8 ± 11.4 years; ejection fraction = 63 ± 8%) referred for known or suspected coronary artery disease. All patients had negative ESE by wall motion criteria. EDV and ESV were measured by biplane Simpson rule with 2-dimensional echocardiography. Cardiac index reserve was identified by peak-rest value. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values ≤2.0). Preload reserve was defined by an increase in EDV. Cardiac index was calculated as stroke volume index * HR (by EKG). HR reserve (stress/rest ratio) <1.85 identified chronotropic incompetence. Results: Of the 1344 patients, 448 were in the lowest tertile of cardiac index reserve with stress. Of them, 303 (67.6%) achieved HR reserve <1.85; 252 (56.3%) had an abnormal LVCR and 341 (76.1%) a reduction of preload reserve, with 446 patients (99.6%) showing ≥1 abnormality. At binary logistic regression analysis, reduced preload reserve (odds ratio [OR]: 5.610; 95% confidence intervals [CI]: 4.025 to 7.821), chronotropic incompetence (OR: 3.923, 95% CI: 2.915 to 5.279), and abnormal LVCR (OR: 1.579; 95% CI: 1.105 to 2.259) were independently associated with lowest tertile of cardiac index reserve at peak stress. Conclusions: Heart rate assessment and volumetric echocardiography during ESE identify the heterogeneity of hemodynamic phenotypes of impaired chronotropic, preload or LVCR underlying a reduced cardiac reserve. MDPI 2021-06-29 /pmc/articles/PMC8267648/ /pubmed/34209955 http://dx.doi.org/10.3390/jcm10132906 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Bombardini, Tonino
Zagatina, Angela
Ciampi, Quirino
Arbucci, Rosina
Merlo, Pablo Martin
Haber, Diego M. Lowenstein
Morrone, Doralisa
D’Andrea, Antonello
Djordjevic-Dikic, Ana
Beleslin, Branko
Tesic, Milorad
Boskovic, Nikola
Giga, Vojislav
de Castro e Silva Pretto, José Luis
Daros, Clarissa Borguezan
Amor, Miguel
Mosto, Hugo
Salamè, Michael
Monte, Ines
Citro, Rodolfo
Simova, Iana
Samardjieva, Martina
Wierzbowska-Drabik, Karina
Kasprzak, Jaroslaw D.
Gaibazzi, Nicola
Cortigiani, Lauro
Scali, Maria Chiara
Pepi, Mauro
Antonini-Canterin, Francesco
Torres, Marco A. R.
Nes, Michele De
Ostojic, Miodrag
Carpeggiani, Clara
Kovačević-Preradović, Tamara
Lowenstein, Jorge
Arruda-Olson, Adelaide M.
Pellikka, Patricia A.
Picano, Eugenio
Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography
title Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography
title_full Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography
title_fullStr Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography
title_full_unstemmed Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography
title_short Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography
title_sort hemodynamic heterogeneity of reduced cardiac reserve unmasked by volumetric exercise echocardiography
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8267648/
https://www.ncbi.nlm.nih.gov/pubmed/34209955
http://dx.doi.org/10.3390/jcm10132906
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