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Impaired biventricular contractile reserve in patients with diastolic dysfunction: insights from exercise stress echocardiography.
- Source :
- European Heart Journal - Cardiovascular Imaging; Aug2022, Vol. 23 Issue 8, p1042-1052, 11p
- Publication Year :
- 2022
-
Abstract
- Aims Cardiac output limitation is a fundamental feature of heart failure with preserved ejection fraction (HFpEF) but the relative contribution of its determinants in symptomatic vs. asymptomatic stages are not well characterized. We aimed to gain insight into disease mechanisms by performing comprehensive comparative non-invasive exercise imaging in patients across the disease spectrum. Methods and results We performed bicycle stress echocardiography in 10 healthy controls, 13 patients with hypertensive left ventricular (LV) concentric remodelling and asymptomatic diastolic dysfunction (HTDD), 15 HFpEF patients, and 15 subjects with isolated right ventricular (RV) dysfunction secondary to chronic thromboembolic pulmonary hypertension (CTEPH). During exercise, ventricular performance differed across the groups (all P ≤ 0.01 for interaction). Notably in controls, LV and RV function significantly increased (all P < 0.05) while both LV systolic and diastolic reserve were significantly reduced in HFpEF patients. Likewise, RV systolic reserve was also impaired in HFpEF but not to the extent of CTEPH patients (P < 0.001 between groups). HTDD patients behaved as an intermediary group with borderline LV systolic and diastolic reserve and reduced RV systolic reserve. The increased pulmonary vascular (PV) load in HFpEF and CTEPH patients in combination with impaired RV reserve resulted in RV–pulmonary artery uncoupling during exercise. Conclusion The multifaceted decline of cardiac and PV function accompanying disease progression in HFpEF is unmasked by exercise and already emerges in preclinical disease. The revelation of these subtle abnormalities during exercise illustrates the benefit of exercise imaging and creates new prospects for early diagnosis and management. [ABSTRACT FROM AUTHOR]
- Subjects :
- ECHOCARDIOGRAPHY
EXERCISE tests
RESEARCH
KRUSKAL-Wallis Test
STATISTICS
ACADEMIC medical centers
CARDIOPULMONARY system
PULMONARY hypertension
VENTRICULAR remodeling
RIGHT heart ventricle
SYSTOLIC blood pressure
OXYGEN consumption
FISHER exact test
DOPPLER echocardiography
THROMBOEMBOLISM
CARDIAC output
DESCRIPTIVE statistics
DATA analysis software
DATA analysis
HEART failure
EARLY diagnosis
EARLY medical intervention
DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 20472404
- Volume :
- 23
- Issue :
- 8
- Database :
- Complementary Index
- Journal :
- European Heart Journal - Cardiovascular Imaging
- Publication Type :
- Academic Journal
- Accession number :
- 159311446
- Full Text :
- https://doi.org/10.1093/ehjci/jeac041