Pre-Load Stress Echocardiography for Predicting the Prognosis in Mild Heart Failure

Yamada, Hirotsugu; Kusunose, Kenya; Nishio, S.; Bando, Mika; Hotchi, Junko; Hayashi, Shuji; Ise, Takayuki; Yagi, Shusuke; Yamaguchi, Koji; Igarashi, Takashi; Soeki, Takeshi; Wakatsuki, Tetsuzo; Sata, Masataka

doi:10.1016/j.jcmg.2014.04.009

Cited by 30 publications

(35 citation statements)

References 23 publications

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“…Preload elevation increased EDP and prolonged . The role of preload stress echocardiography in HF prognosis stratification has been recently advocated (29). With ␣-adrenergic drug phenylephrine infusion, we observed higher MAP without significant changes in EDV i or HR and therefore selectively increased afterload.…”

Section: Discussionmentioning

confidence: 60%

Echocardiography and invasive hemodynamics during stress testing for diagnosis of heart failure with preserved ejection fraction: an experimental study

Leite

Oliveira‐Pinto

Tavares-Silva

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

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Leite S, Oliveira-Pinto J, Tavares-Silva M, Abdellatif M, Fontoura D, Falcão-Pires I, Leite-Moreira AF, Lourenço AP. Echocardiography and invasive hemodynamics during stress testing for diagnosis of heart failure with preserved ejection fraction: an experimental study. Am J Physiol Heart Circ Physiol 308: H1556 -H1563, 2015. First published April 11, 2015; doi:10.1152/ajpheart.00076.2015.-Inclusion of exercise testing in diagnostic guidelines for heart failure with preserved ejection fraction (HFpEF) has been advocated, but the target population, technical challenges, and underlying pathophysiological complexity raise difficulties to implementation. Hemodynamic stress tests may be feasible alternatives. Our aim was to test Trendelenburg positioning, phenylephrine, and dobutamine in the ZSF1 obese rat model to find echocardiographic surrogates for end-diastolic pressure (EDP) elevation and HFpEF. Seventeen-week-old WistarKyoto, ZSF1 lean, and obese rats (n ϭ 7 each) randomly and sequentially underwent (crossover) Trendelenburg (30°), 5 g·Kg Ϫ1 ·min Ϫ1 dobutamine, and 7.5 g·Kg Ϫ1 ·min Ϫ1 phenylephrine with simultaneous left ventricular (LV) pressure-volume loop and echocardiography evaluation under halogenate anesthesia. Effort testing with maximum O2 consumption (V O2 max) determination was performed 1 wk later. Obese ZSF1 showed lower effort tolerance and V O2 max along with higher resting EDP. Both Trendelenburg and phenylephrine increased EDP, whereas dobutamine decreased it. Significant correlations were found between EDP and 1) peak early filling Doppler velocity of transmitral flow (E) to corresponding myocardial tissue Doppler velocity (E=) ratio, 2) E to E-wave deceleration time (E/DT) ratio, and 3) left atrial area (LAA). Diagnostic efficiency of E/DT*LAA by receiver-operating characteristic curve analysis for elevation of EDP above a cut-off of 13 mmHg during hemodynamic stress was high (area under curve, AUC ϭ 0.95) but not higher than that of E/E= (AUC ϭ 0.77, P ϭ 0.15). Results in ZSF1 obese rats suggest that noninvasive echocardiography after hemodynamic stress induced by phenylephrine or Trendelenburg can enhance diagnosis of stable HFpEF and constitute an alternative to effort testing. heart failure with preserved

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Section: Discussionmentioning

confidence: 60%

Echocardiography and invasive hemodynamics during stress testing for diagnosis of heart failure with preserved ejection fraction: an experimental study

Leite

Oliveira‐Pinto

Tavares-Silva

et al. 2015

American Journal of Physiology-Heart and Circulatory Physiology

View full text Add to dashboard Cite

show abstract

“…Because pressure–volume analysis by conductance catheter is too complicated for daily clinical routine practice, the assessment of LV diastolic compliance remains challenging. To address this problem, we had developed preload stress echocardiography using LPP (+90 mm Hg) . Using our technique, we could separate patients with preserved LV compliance and those with impaired LV compliance.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, we could perform the LPP during echocardiography in all the subjects. It is a safe, reversible, and reproducible maneuver for increasing preload stress without increasing systemic blood pressure and heart rate …”

Section: Discussionmentioning

confidence: 99%

“…Our subjects whose TMF pattern showed IR pattern were classified into less than diastolic dysfunction grade 2 (with normal LA pressure). In such patients, response of TMF pattern during LPP was the beneficial parameter for predicting their prognosis . In the preceding study, primary endpoints were death and/or hospitalization for heart failure, and we visually evaluated the change of pattern in TMF profile during LPP.…”

Section: Discussionmentioning

confidence: 99%

“…This procedure does not significantly increase either heart rate or systolic blood pressure in the previous invasive study. Thus, we can provide pure preload augmentation using this technique . When hemodynamic conditions had stabilized, echocardiographic data were acquired.…”

Section: Methodsmentioning

confidence: 99%

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