Impact of Ventricular Dyssynchrony on Postexercise Accommodation of Systolic Myocardial Motion in Hypertensive Patients With Heart Failure and a Normal Ejection Fraction: A Tissue-Doppler Echocardiography Study

Wang, Yi Chih; Yu, Chih Chieh; Chiu, Fu-Chun; Klepfer, Ruth Nicholson; Hilpisch, Kathryn; Splett, Vincent; Tsai, Chia Ti; Lai, Ling‐Ping; Hwang, Juey Jen; Lin, Jiunn Lee

doi:10.1016/j.cardfail.2011.10.018

Cited by 8 publications

(15 citation statements)

References 21 publications

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“…Thirty‐eight studies were selected ( Tables and ). These included 1111 patients with HFPEF; 458 healthy controls (enrolled in 45% of the studies, and usually matched for age); and 744 patients with normal EF used as controls who had hypertension, diabetes mellitus (with or without breathlessness), non‐cardiac causes of dyspnoea (attributed to obesity, obstructive airways disease, restrictive airways disease), chest discomfort without symptoms of heart failure (before scheduled angiography to exclude coronary disease), atypical chest pain without coronary disease but with invasive evidence of normal diastolic function, or fatigue or dyspnoea but without diastolic dysfunction.…”

Section: Resultsmentioning

confidence: 99%

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A systematic review of diastolic stress tests in heart failure with preserved ejection fraction, with proposals from the EU‐FP7 MEDIA study group

Erdei

Smiseth

Marino

et al. 2014

European J of Heart Fail

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Aims Cardiac function should be assessed during stress in patients with suspected heart failure with preserved ejection fraction (HFPEF), but it is unclear how to define impaired diastolic reserve. Methods and results We conducted a systematic review to identify which pathophysiological changes serve as appropriate targets for diagnostic imaging. We identified 38 studies of 1111 patients with HFPEF (mean age 65 years), 744 control patients without HFPEF, and 458 healthy subjects. Qualifying EF was >45–55%; diastolic dysfunction at rest was a required criterion in 45% of studies. The initial workload during bicycle exercise (25 studies) varied from 12.5 to 30 W (mean 23.1 ± 4.6), with increments of 10–25 W (mean 19.9 ± 6) and stage duration 1–5 min (mean 2.5 ± 1); targets were submaximal (n = 8) or maximal (n = 17). Other protocols used treadmill exercise, handgrip, dobutamine, lower body negative pressure, nitroprusside, fluid challenge, leg raising, or atrial pacing. Reproducibility of echocardiographic variables during stress and validation against independent reference criteria were assessed in few studies. Change in E/e' was the most frequent measurement, but there is insufficient evidence to establish this or other tests for routine use when evaluating patients with HFPEF. Conclusions To meet the clinical requirements of performing stress testing in elderly subjects, we propose a ramped exercise protocol on a semi‐supine bicycle, starting at 15 W, with increments of 5 W/min to a submaximal target (heart rate 100–110 b.p.m., or symptoms). Measurements during submaximal and recovery stages should include changes from baseline in LV long‐axis function and indirect echocardiographic indices of LV diastolic pressure.

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Section: Resultsmentioning

confidence: 99%

“…In three studies, the purpose of the investigation was the diagnosis of early HFPEF in a patient with normal resting haemodynamics. In seven studies, both HFPEF subjects and patients with hypertension but without HFPEF underwent stress testing (see footnotes to Tables and ).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of diastolic stress tests in heart failure with preserved ejection fraction, with proposals from the EU‐FP7 MEDIA study group

Erdei

Smiseth

Marino

et al. 2014

European J of Heart Fail

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“…To test the hypothesis of the study, an inclusion criterion of mechanical dyssynchrony was included. In all subjects, the dyssynchrony seen at screening matched a previously identified ventricular dyssynchrony signature of an abrupt increase in Ts in the lateral and posterior segments [14,17]. This mechanical dyssynchrony was not accompanied by electrical dyssynchrony since all subjects had a narrow QRS width.…”

Section: Discussionmentioning

confidence: 66%

Acute Effects of Biventricular Pacing in Heart Failure Patients with a Normal Ejection Fraction and Mechanical Dyssynchrony

Wang

Chiu

et al. 2015

Cardiology

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Objectives: We tested the acute effects of resynchronization in heart failure patients with a normal (>50%) left ventricular (LV) ejection fraction (HFNEF) and mechanical dyssynchrony. Methods: Twenty-four HFNEF patients (72 ± 6 years, 5 male) with mechanical dyssynchrony (standard deviation of electromechanical time delay among 12 LV segments >35 ms) were studied with temporary pacing catheters in the right atrium, LV, and right ventricle (RV), and high-fidelity catheters for pressure recording. Using selected atrioventricular (AV) intervals of 60, 90, 120, 150, and 180 ms to optimize transmitral flow during simultaneous biventricular pacing, the RV-LV (VV) interval was then evaluated at RV30, RV15, 0, LV15, LV30, and LV45 (RV or LV indicates which ventricle was paced first, the number indicates by how many ms). Results: During simultaneous pacing, longer AV intervals were associated with improved LV pressure-derivative minimums and increased aortic pressures (p < 0.05 vs. normal sinus rhythm). In the VV interval from RV30 to LV45, there was a graded increase in the aortic velocity time integral and a decrease in dyssynchrony during simultaneous or LV-first pacing (p < 0.05 vs. normal sinus rhythm). Conclusions: For HFNEF patients with mechanical dyssynchrony, acute simultaneous biventricular or LV-first pacing with longer AV intervals reduced mechanical dyssynchrony and improved diastolic and systolic hemodynamics.

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“…Furthermore, when evaluating post-exercise systolic myocardial motion in HFpEF patients, the possible detrimental role of underlying systolic ventricular dyssynchrony derived by TDI should be considered. Our earlier study demonstrated that the presence of systolic dyssynchrony in HFpEF patients was associated with the significantly poorer adaptation of mean systolic myocardial motion to exercise (6.6 ± 0.9 to 7.9 ± 1.3 cm/s) when compared with those without dyssynchrony (6.8 ± 1.0 to 8.6 ± 1.5 cm/s) [7]. Therefore, we further compared the pharmacological efficacy of aldosterone antagonism on HFpEF patients based on the presence or absence of ventricular dyssynchrony in the spironolactone arm.…”

Section: Introductionmentioning

confidence: 92%

Poorer Exercise Accommodation of Regional Systolic Myocardial Motion after Spironolactone Treatment in Heart Failure Patients with Preserved Ejection Fraction and Ventricular Dyssynchrony

Chiu

Tsai

et al. 2021

JCM

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Patients with heart failure and preserved ejection fraction (HFpEF) are known to have reduced systolic myocardial velocity (Sm) with impaired accommodation to exercise. We tested the impact of an aldosterone antagonist on Sm at rest and post-exercise. Forty-nine HFpEF patients (65 ± 11 years, 24 male) with HF signs/symptoms, mitral E/Ea (annular early diastolic velocity) > 8, and left ventricular (LV) EF > 50% were randomized to spironolactone (25 mg/day, 25 patients) or the Control. At baseline and 6 months, we analyzed Sm of basal LV segments at rest and after a 6 min treadmill exercise. At 6 months, post-exercise mean Sm in the spironolactone group became greater than that in the Control (9.2 ± 1.6 vs. 8.3 ± 1.0 cm/s, p = 0.021), mainly due to the increment of post-exercise % increase of lateral Sm (44 ± 30 vs. 30 ± 19% at baseline, p = 0.045). Further analyses showed the presence of systolic dyssynchrony (standard deviation of electromechanical delay of 6-basal LV segments > 35 ms) was independently associated with a poorer response to spironolactone, defined as a post-exercise % increase of lateral Sm < 50% (OR = 2.7, 95% CI = 1.8–4.2) and the increment of Ea < 1.5 cm/s (OR = 1.5, 95% CI = 1.1–2.3). Spironolactone could improve exercise accommodation of regional systolic myocardial velocity for HFpEF patients. However, its benefits could be decreased in those with ventricular dyssynchrony. This suggested possible therapeutic impacts from underlying heterogeneity within HFpEF patients.

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Impact of Ventricular Dyssynchrony on Postexercise Accommodation of Systolic Myocardial Motion in Hypertensive Patients With Heart Failure and a Normal Ejection Fraction: A Tissue-Doppler Echocardiography Study

Cited by 8 publications

References 21 publications

A systematic review of diastolic stress tests in heart failure with preserved ejection fraction, with proposals from the EU‐FP7 MEDIA study group

A systematic review of diastolic stress tests in heart failure with preserved ejection fraction, with proposals from the EU‐FP7 MEDIA study group

Acute Effects of Biventricular Pacing in Heart Failure Patients with a Normal Ejection Fraction and Mechanical Dyssynchrony

Poorer Exercise Accommodation of Regional Systolic Myocardial Motion after Spironolactone Treatment in Heart Failure Patients with Preserved Ejection Fraction and Ventricular Dyssynchrony

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