Contractile reserve and cardiopulmonary exercise parameters in patients with dilated cardiomyopathy, the two dimensions of exercise testing

Moneghetti, Kegan; Kobayashi, Yukari; Christle, Jeffrey W.; Ariyama, Miyuki; Vrtovec, Bojan; Kouznetsova, Tatiana; Wilson, A. S.; Ashley, Euan A.; Wheeler, Matthew T.; Myers, J.; Haddad, François

doi:10.1111/echo.13623

Cited by 9 publications

(6 citation statements)

References 40 publications

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“…A lack of contractile reserve might lead to development or worsening of mitral regurgitation, cardiac failure, and arrhythmias [23]. A contractile reserve to exercise has been found to be associated to other markers of poor outcome like maximum O2 consumption and functional capacity [24]. Our patients with a negative CR also had worse functional capacity that those with a positive CR.…”

Section: Discussionmentioning

confidence: 69%

Exercise Contractile Reserve for Predicting Mortality in Non-Ischemic Ventricular Dysfunction

Bouzas‐Mosquera¹,

Rebollal²,

Broullón³

et al. 2019

RDI

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Objectives: A preserved contractile reserve is a marker of favorable outcome in different cardiac diseases. In some studies, using drugs, an increase in left ventricular (LV) systolic function was associated to better prognosis in patients with dilated cardiomyopathy. We aimed to assess whether a positive contractile reserve (CR) to physical exercise is a marker of good outcome in patients with LV systolic dysfunction not related to coronary artery disease (CAD). Design: From our exercise echocardiography database we extracted patients with LV systolic dysfunction (LVEF ≤45), negative coronary angiography, and absence of a history of CAD. A positive CR was considered when peak LVEF was higher that resting LVEF. The endpoint was overall mortality. Results and Conclusions: Among the 225 patients included, 105 had a positive CR and 120 a negative CR. Resting LV function was similar in patients with positive and negative CR (LVEF 35±8 vs. 34±9; wall motion score index 1.81±0.34 vs. 1.80±0.29; both p=NS). During a follow up of 6.2+4.7 years (25-75th percentiles 2.2-9.5), there were 71 deaths. Ten-year mortality rates were 34% for patients with CR and 67% for patients without CR (p=0.003). After multivariate adjustment that included clinical variables, medications, resting LV function, and exercise testing variables the only predictors of death were age (hazard ratio (HR) 1.07, 95% Confidence Interval (CI) 1.04-1.10, p<0.001), and absence of CR (HR 1.80, 95% CI 1.09-2.98, p=0.02). In conclusion, in patients with non- ischemic LV dysfunction, a positive CR to physical exercise is a marker of better outcome.

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Section: Discussionmentioning

confidence: 69%

Exercise Contractile Reserve for Predicting Mortality in Non-Ischemic Ventricular Dysfunction

Bouzas‐Mosquera¹,

Rebollal²,

Broullón³

et al. 2019

RDI

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“…A rational explanation may be that the patients were very well medicated and based on the Kansas City Cardiomyopathy Questionnaire in a well general state. Nevertheless, additional information of the contractile reserve could have been meaningful to clarify our observations [46]. Regarding the risk stratification of chronic heart failure, maximum oxygen uptake is the established gold standard [6].…”

Section: Discussionmentioning

confidence: 99%

Non-invasively measured central and peripheral factors of oxygen uptake differ between patients with chronic heart failure and healthy controls

Brochhagen

Barroso

Baumgart

et al. 2020

BMC Cardiovasc Disord

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Background: Maximum oxygen uptake is an established measurement of diagnosing chronic heart failure and underlies various central and peripheral factors. However, central and peripheral factors are little investigated, because they are usually measured invasively. The aim of this study was to compare non-invasively measured central and peripheral factors of oxygen uptake between patients with chronic heart failure and healthy controls. Methods: Ten male patients with heart failure with reduced ejection fraction (62 ± 4 years; body mass index: 27.7 ± 1.8 kg/m 2 ; ejection fraction: 30 ± 4%) and ten male healthy controls (59 ± 3 years; body mass index: 27.7 ± 1.3 kg/m 2) were tested for blood pressure, heart rate, stroke volume, cardiac output, and cardiac power output (central factors) as well as muscle oxygen saturation of the vastus lateralis and biceps brachii muscle (peripheral factors) during an incremental cycling test. Stroke volume and muscle oxygen saturation were non-invasively measured by a bioreactance analysis and near-infrared spectroscopy, respectively. Additionally, a maximum isometric strength test of the knee extensors was conducted. Magnitude-based inferences were computed for statistical analyses. Results: Patients had a likely to most likely lower oxygen uptake, mean arterial pressure, and heart rate at maximum load as well as very likely lower isometric peak torque. Contrary, patients had a possibly to likely higher stroke volume and muscle oxygen saturation of the vastus lateralis muscle at maximum load. Differences in cardiac output, cardiac power output, and muscle oxygen saturation of the biceps brachii muscle at maximum load were unclear. Conclusions: Non-invasively measured central and peripheral factors of oxygen uptake differ between patients with chronic heart failure and healthy controls. Therefore, it is promising to measure both types of factors in patients with chronic heart failure to optimize the diagnosis and therapy.

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“…This scoping review will be conducted in accordance with the JBI methodology for scoping reviews [ 31 ], based on earlier work from Arksey and O’Malley [ 32 ]. It will follow the process of (1) identifying the research question; (2) identifying the relevant studies; (3) defining criteria for study inclusion; (4) data charting; (5) collation, summarizing, and reporting of results; and (6) peer feedback [ 29 ]. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) [ 33 ] checklist will be followed.…”

Section: Methodsmentioning

confidence: 99%

“…Recently the combination of cardiopulmonary exercise test-stress echocardiography (CPET-SE) has been used to explore cardiopulmonary dysfunction. Studies have explored the role of CPET-SE in exploring conditions such as dyspnea [ 26 ], heart failure [ 27 , 28 ], contractile reserve [ 29 ], and left atrial dysfunction [ 30 ]. While the application is broad, the indications for this test combination remain undefined, and there is no consensus regarding the optimal protocol for the exercise and imaging components.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Cardiopulmonary Exercise Testing and Echocardiography for Investigation of Cardiopulmonary Dysfunction in Outpatients: Protocol for a Scoping Review

Gerhardy,

Sivapathan,

Orde

et al. 2024

JMIR Res Protoc

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Background Cardiopulmonary dysfunction is a complex process with a broad range of etiologies. Investigations performed either at rest or those that only assess the function of a single organ (heart or lungs) are often insufficient. A simultaneous cardiopulmonary exercise test with stress echocardiography is a new approach to assessing cardiopulmonary dysfunction as it provides anatomical and functional imaging simultaneously while under increasing stress. To date, the application of cardiopulmonary exercise test-stress echocardiography (CPET-SE) has been broad and without structure, and its effect on patient outcomes is unclear. Objective The objective of this scoping review is to explore and analyze the evidence regarding the role of simultaneous CPET-SE in investigating cardiopulmonary dysfunction in outpatients. It will include any published study in which adult (older than or equal to 18 years of age) patients have completed a CPET-SE for the investigation of cardiopulmonary dysfunction. Methods This review will follow the Arksey and O’Malley framework, supported by the Joanna Briggs Institute methodology for scoping reviews. It will use the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. Data sources will include MEDLINE, Scopus, Embase, and Cochrane (including reviews, trials, and protocols) electronic databases, with no date range defined. The search will be limited to the English language with no restrictions regarding pathology. Secondary references of the included sources will also be assessed by a hand search for suitability. A 2-person title-abstract screen and data charting process will be used. Independent experts will be used for consultation including an academic librarian and clinicians. The Covidence software will be used for article screening. Results This scoping review will provide a unified and detailed description of the applications of CPET-SE in investigating cardiopulmonary dysfunction. This will provide a platform for future research harnessing this investigatory method. The results will be presented in both tabular and graphical formats to ensure clarity. The results of this scoping review will be submitted to a relevant peer-reviewed academic journal for publication. Conclusions The CPET-SE is a powerful tool for investigating cardiopulmonary dysfunction but remains in its infancy with a patchwork approach to indications, data reporting, and interpretation. This scoping review will unify the literature and provide a platform for future researchers and the development of a comprehensive application guideline. Trial Registration Open Science Framework; https://osf.io/98r3e International Registered Report Identifier (IRRID) PRR1-10.2196/52076

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Contractile reserve and cardiopulmonary exercise parameters in patients with dilated cardiomyopathy, the two dimensions of exercise testing

Abstract: Echocardiographic contractile reserve and CPX provide complementary information. Percent change in contractile reserve was most independent of baseline function, therefore may be preferred when analyzing the ventricular response to exercise.

Cited by 9 publications

References 40 publications

Exercise Contractile Reserve for Predicting Mortality in Non-Ischemic Ventricular Dysfunction

Exercise Contractile Reserve for Predicting Mortality in Non-Ischemic Ventricular Dysfunction

Non-invasively measured central and peripheral factors of oxygen uptake differ between patients with chronic heart failure and healthy controls

Simultaneous Cardiopulmonary Exercise Testing and Echocardiography for Investigation of Cardiopulmonary Dysfunction in Outpatients: Protocol for a Scoping Review

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