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Coronary Flow, Left Ventricular Contractile and Heart Rate Reserve in Non-Ischemic Heart Failure

Background: Left ventricular contractile reserve (LVCR), coronary flow velocity reserve (CFVR), and heart rate reserve (HRR) affect outcome in heart failure (HF). They can be simultaneously measured during dipyridamole stress echocardiography (DSE). Aim: To assess the value of comprehensive DSE in p...

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Autores principales: Daros, Clarissa Borguezan, Ciampi, Quirino, Cortigiani, Lauro, Gaibazzi, Nicola, Rigo, Fausto, Wierzbowska-Drabik, Karina, Kasprzak, Jaroslaw D., Dodi, Claudio, Villari, Bruno, Antonini-Canterin, Francesco, Lorenzoni, Valentina, Nes, Michele De, Carpeggiani, Clara, Picano, Eugenio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347234/
https://www.ncbi.nlm.nih.gov/pubmed/34362186
http://dx.doi.org/10.3390/jcm10153405
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author Daros, Clarissa Borguezan
Ciampi, Quirino
Cortigiani, Lauro
Gaibazzi, Nicola
Rigo, Fausto
Wierzbowska-Drabik, Karina
Kasprzak, Jaroslaw D.
Dodi, Claudio
Villari, Bruno
Antonini-Canterin, Francesco
Lorenzoni, Valentina
Nes, Michele De
Carpeggiani, Clara
Picano, Eugenio
author_facet Daros, Clarissa Borguezan
Ciampi, Quirino
Cortigiani, Lauro
Gaibazzi, Nicola
Rigo, Fausto
Wierzbowska-Drabik, Karina
Kasprzak, Jaroslaw D.
Dodi, Claudio
Villari, Bruno
Antonini-Canterin, Francesco
Lorenzoni, Valentina
Nes, Michele De
Carpeggiani, Clara
Picano, Eugenio
author_sort Daros, Clarissa Borguezan
collection PubMed
description Background: Left ventricular contractile reserve (LVCR), coronary flow velocity reserve (CFVR), and heart rate reserve (HRR) affect outcome in heart failure (HF). They can be simultaneously measured during dipyridamole stress echocardiography (DSE). Aim: To assess the value of comprehensive DSE in patients with non-ischemic HF. Methods: We evaluated 610 patients with HF, no history of coronary artery disease, and no inducible regional wall motion abnormalities: 270 patients with preserved ejection fraction (≥50%), 146 patients with mid-range ejection fraction (40–49%), and 194 patients with reduced ejection fraction (<40%). All underwent DSE (0.84 mg/kg in 6′) in 7 accredited laboratories. We measured LVCR (abnormal value ≤ 1.1), CFVR in left anterior descending artery (abnormal value: ≤2.0), and HRR (peak/rest heart rate; abnormal value: ≤1.22). All patients were followed up. Results: Abnormal CFVR, LVCR, and HRR occurred in 29%, 45%, and 47% of patients, respectively (p < 0.001). After a median follow-up time of 20 months (interquartile range: 12–32 months), 113 hard events occurred in 105 patients with 41 deaths, 8 myocardial infarctions, 61 admissions for acute HF, and 3 strokes. The annual mortality rates were 0.8% in 200 patients with none abnormal criteria, 1.8% in 184 patients with 1 abnormal criterion, 7.1% in 130 patients with 2 abnormal criteria, 7.5% in 96 patients with 3 abnormal criteria. Conclusions: Abnormal LVCR, CFVR, and HRR were frequent during DSE in non-ischemic HF patients. They target different pathophysiological vulnerabilities (myocardial function, coronary microcirculation, and cardiac autonomic balance) and are useful for outcome prediction.
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spelling pubmed-83472342021-08-08 Coronary Flow, Left Ventricular Contractile and Heart Rate Reserve in Non-Ischemic Heart Failure Daros, Clarissa Borguezan Ciampi, Quirino Cortigiani, Lauro Gaibazzi, Nicola Rigo, Fausto Wierzbowska-Drabik, Karina Kasprzak, Jaroslaw D. Dodi, Claudio Villari, Bruno Antonini-Canterin, Francesco Lorenzoni, Valentina Nes, Michele De Carpeggiani, Clara Picano, Eugenio J Clin Med Article Background: Left ventricular contractile reserve (LVCR), coronary flow velocity reserve (CFVR), and heart rate reserve (HRR) affect outcome in heart failure (HF). They can be simultaneously measured during dipyridamole stress echocardiography (DSE). Aim: To assess the value of comprehensive DSE in patients with non-ischemic HF. Methods: We evaluated 610 patients with HF, no history of coronary artery disease, and no inducible regional wall motion abnormalities: 270 patients with preserved ejection fraction (≥50%), 146 patients with mid-range ejection fraction (40–49%), and 194 patients with reduced ejection fraction (<40%). All underwent DSE (0.84 mg/kg in 6′) in 7 accredited laboratories. We measured LVCR (abnormal value ≤ 1.1), CFVR in left anterior descending artery (abnormal value: ≤2.0), and HRR (peak/rest heart rate; abnormal value: ≤1.22). All patients were followed up. Results: Abnormal CFVR, LVCR, and HRR occurred in 29%, 45%, and 47% of patients, respectively (p < 0.001). After a median follow-up time of 20 months (interquartile range: 12–32 months), 113 hard events occurred in 105 patients with 41 deaths, 8 myocardial infarctions, 61 admissions for acute HF, and 3 strokes. The annual mortality rates were 0.8% in 200 patients with none abnormal criteria, 1.8% in 184 patients with 1 abnormal criterion, 7.1% in 130 patients with 2 abnormal criteria, 7.5% in 96 patients with 3 abnormal criteria. Conclusions: Abnormal LVCR, CFVR, and HRR were frequent during DSE in non-ischemic HF patients. They target different pathophysiological vulnerabilities (myocardial function, coronary microcirculation, and cardiac autonomic balance) and are useful for outcome prediction. MDPI 2021-07-30 /pmc/articles/PMC8347234/ /pubmed/34362186 http://dx.doi.org/10.3390/jcm10153405 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
Daros, Clarissa Borguezan
Ciampi, Quirino
Cortigiani, Lauro
Gaibazzi, Nicola
Rigo, Fausto
Wierzbowska-Drabik, Karina
Kasprzak, Jaroslaw D.
Dodi, Claudio
Villari, Bruno
Antonini-Canterin, Francesco
Lorenzoni, Valentina
Nes, Michele De
Carpeggiani, Clara
Picano, Eugenio
Coronary Flow, Left Ventricular Contractile and Heart Rate Reserve in Non-Ischemic Heart Failure
title Coronary Flow, Left Ventricular Contractile and Heart Rate Reserve in Non-Ischemic Heart Failure
title_full Coronary Flow, Left Ventricular Contractile and Heart Rate Reserve in Non-Ischemic Heart Failure
title_fullStr Coronary Flow, Left Ventricular Contractile and Heart Rate Reserve in Non-Ischemic Heart Failure
title_full_unstemmed Coronary Flow, Left Ventricular Contractile and Heart Rate Reserve in Non-Ischemic Heart Failure
title_short Coronary Flow, Left Ventricular Contractile and Heart Rate Reserve in Non-Ischemic Heart Failure
title_sort coronary flow, left ventricular contractile and heart rate reserve in non-ischemic heart failure
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347234/
https://www.ncbi.nlm.nih.gov/pubmed/34362186
http://dx.doi.org/10.3390/jcm10153405
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