A clinical application of preload stress echocardiography for predicting future hemodynamic worsening in patients with early‐stage heart failure

Saijo, Yoshifumi; Yamada, Hirotsugu; Kusunose, Kenya; Bando, Mika; Nishio, S.; Torii, Yasuhiro; Hirata, Yoshihiro; Seno, Hiromitsu; Matsuura, Tomomi; Ise, Takayuki; Tobiume, Takeshi; Yamaguchi, Koji; Yagi, Shusuke; Soeki, Takeshi; Wakatsuki, Tetsuzo; Sata, Masataka

doi:10.1111/echo.14098

Cited by 4 publications

(2 citation statements)

References 29 publications

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“…Several investigators showed that the responses of mitral inflow to nitroprusside or leg lifting identified subgroups of patients who have markedly different prognoses despite similar baseline mitral inflow patterns 6,7 . In our previous papers, we used leg‐positive pressure (LPP) as an alternative technique for non‐invasive preload augmentation, and we estimated the LV diastolic reserve by the change in mitral inflow pattern 8–11 . Impaired responses to an increment during preload stress provided additional prognostic information to conventional echocardiographic parameters in HF 12,13 .…”

Section: Introductionmentioning

confidence: 99%

“…6,7 In our previous papers, we used leg-positive pressure (LPP) as an alternative technique for non-invasive preload augmentation, and we estimated the LV diastolic reserve by the change in mitral inflow pattern. [8][9][10][11] Impaired responses to an increment during preload stress provided additional prognostic information to conventional echocardiographic parameters in HF. 12,13 Thus, abnormal LV diastolic response to preload stress can be an occult sign of HF.…”

Section: Introductionmentioning

confidence: 99%

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Clinical course and decision‐making in heart failure by preload stress echocardiography: a preliminary study

et al. 2022

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Aims Abnormal left ventricular diastolic response to preload stress can be an early marker of heart failure (HF). The aim of this study was to assess clinical course in patients with HF with preserved ejection fraction (HFpEF) who underwent preload stress echocardiography. In the subgroup analysis, we assessed the prognosis of patients with unstable signs during preload stress classified by treatment strategies. Methods and resultsWe prospectively conducted preload stress echocardiographic studies between January 2006 and December 2013 in 211 patients with HFpEF. Fifty-eight patients had abnormal diastolic reserve during preload stress (unstable impaired relaxation: unstable IR). Of 58 patients with unstable IR, 19 patients were assigned to additional therapy by increased or additional therapy and 39 patients were assigned to standard therapy. Composite outcomes were prespecified as the primary endpoint of death and hospitalization for deteriorating HF. During a median period of 6.9 years, 19 patients (33%) reached the composite outcome. Unstable group with standard therapy had significantly shorter event-free survival than stable group. Patients with uptitration of therapy had longer event-free survival than those with standard therapy group after adjustment of laboratory data (hazard ratio, 0.20, 95% confidence interval, 0.05-0.90; P = 0.036); the 10 year event-free survival in patients with and without uptitration of therapy was 93% and 51%, respectively (P = 0.023). Conclusions Patients with unstable sign had significantly shorter event-free survival than patients with stable sign. After additional therapy, the prognosis of patients with unstable signs improved. This technique may impact decision-making for improving their prognosis.

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confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical course and decision‐making in heart failure by preload stress echocardiography: a preliminary study

et al. 2022

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Clinical application of stress echocardiography for valvular heart disease

Kusunose

2019

J Med Ultrasonics

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Valvular heart diseases (VHDs) constitute an increasing problem both as a consequence of population aging and as the sequelae of other heart diseases. Accurate diagnosis is essential for correct clinical decision -making; however, in many patients, transthoracic and transesophageal echocardiography is insufficient. Stress echocardiography (SE) proved to be a useful tool allowing for simultaneous assessment of left ventricular contractile reserve and HVD hemodynamics under conditions of physiological or pharmacological stress. It is recommended for assessing the severity of VHD, guiding the choice of treatment, as well as for surgical risk stratification. It can be applied both in asymptomatic patients with severe VHD and in symptomatic individuals with moderate disease. In patients with VHD, SE can be performed either as exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE). The first modality is recommended to unmask symptoms or abnormal blood pressure response in patients with aortic stenosis (AS) who report to be asymptomatic or in those with mitral stenosis with discordance between clinical symptoms and the severity of valve disease on transthoracic echocardiography. In asymptomatic patients with paradoxical low -flow, low -gradient (LFLG) AS, ESE can be used to assess the severity of stenosis. On the other hand, low -dose DSE can be a useful diagnostic tool in classical LFLG AS, providing information on stenosis severity and contractile reserve. Moreover, SE is indicated in patients with prosthetic valve when there is discordance between symptoms and echocardiographic findings. It is also recommended in high -risk surgical patients with VHD with poor functional capacity and more than 2 clinical risk factors. The present paper discusses in detail the use of SE in VHD.

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Clinical Application of Stress Echocardiography in Management of Heart Failure

Kusunose

2020

Heart Failure Clinics

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A clinical application of preload stress echocardiography for predicting future hemodynamic worsening in patients with early‐stage heart failure

Abstract: Evaluation of a response in TMF during the LPP might provide an incremental diagnostic value to detect future overt heart failure in patients with early-stage heart failure.

Cited by 4 publications

References 29 publications

Clinical course and decision‐making in heart failure by preload stress echocardiography: a preliminary study

Clinical course and decision‐making in heart failure by preload stress echocardiography: a preliminary study

Clinical application of stress echocardiography for valvular heart disease

Clinical Application of Stress Echocardiography in Management of Heart Failure

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