Stress echocardiography in heart failure

Abstract

Echocardiography has the ability to noninvasively explore hemodynamic variables during pharmacologic or exercise stress test in patients with heart failure. In this review, we detail some important potential applications of stress echocardiography in patients with heart failure. In patients with coronary artery disease and chronic LV dysfunction, dobutamine stress echocardiography is able to distinguish between viable and fibrotic tissue to make adequate clinical decisions. Exercise testing, in combination with echocardiographic monitoring, is a method of obtaining accurate information in the assessment of functional capacity and prognosis. Functional mitral regurgitation is a common finding in patients with dilated and ischaemic cardiomyopathy and stress echocardiography in the form of exercise or pharmacologic protocols can be useful to evaluate the behaviour of mitral regurgitation. It is clinical useful to search the presence of contractile reserve in non ischemic dilated cardiomyopathy such as to screen or monitor the presence of latent myocardial dysfunction in patients who had exposure to cardiotoxic agents. Moreover, in patients with suspected diastolic heart failure and normal systolic function, exercise echocardiography could be able to demonstrate the existence of such dysfunction and determine that it is sufficient to limit exercise tolerance. Finally, in the aortic stenosis dobutamine echocardiography can distinguish severe from non-severe stenosis in patients with low transvalvular gradients and depressed left ventricular function.

Negative stress echo: Further prognostic stratification with assessment of pressure–volume relation

“…When a physiological (exercise) stress echo is scheduled, interest is focused on wall motion segmental contraction abnormality to diagnose ischemic response to stress [9] and on LVEF to assess contractile reserve: the critical level to define the presence of contractile reserve is generally defined as an increase of at least 5% (in absolute terms) in the global LVEF [27]. However, ejection fraction is a very gross index of left ventricular performance.…”

Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

“…37,[41][42][43][44] Exercise testing, in combination with echocardiographic monitoring, may be an attractive and practical method of obtaining accurate information that can aid in the assessment of contractile reserve and prognosis. 38) Observations from previous studies have shown that the capacity for exercise in patients with advanced HF may in fact be more closely related to RV rather than LV performance. 9) RV dysfunction predicts an impaired contractile reserve and decreased survival in patients with both moderate and advanced HF.…”

“…9,[36][37][38][39][40] These conventional parameters during exercise could show a reserve of cardiac function, activity, and quality of life in patients with HF, but those at rest could not. We need to determine the responses to therapy that lead to a good prognosis in patients with DCM.…”

Ischemic cardiomyopathy: possibilities of surgical treatment

“…Išemine KMP sergantiems pacientams, kuriems medikamentinis ŠN gydymas neveiksmingas, atlikta KS rekonstrukcinė operacija žymiai sumažina simptomus, o KS galinis diastolinis tūrio sumažinimas iki <150 ml po operacijos leidžia prognozuoti gerus trumpalaikius rezultatus (15). Jeigu KS galinis sistolinis tūris didelis (140 ml) dėl KS remodeliavimosi, KS funkcijos pagerėjimo tikimybė yra maža (21). Po MI susiformavusi KS aneurizma yra nepriklausomas blogos prognozės požymis.…”