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1.
Kardiologiia ; 61(2): 62-68, 2021 Mar 06.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-33734048

RESUMO

Aim      To determine diagnostic capabilities of the expanded protocol for stress echocardiography (stress-EchoCG) with comprehensive evaluation of clinical and echocardiographic indexes in differential diagnosis of dyspnea.Material and methods This study included 243 patients (123 women and 120 men) who were referred to outpatient stress-EchoCG during one calendar month. For 80 patients complaining about shortness of breath, the expanded stress-EchoCG protocol with treadmill exercise was performed. During the exercise, E / e' and tricuspid regurgitation velocity were determined, and clinical features and possible nature of dyspnea were evaluated.Results Shortness of breath had an ischemic origin in 17.5 % of 80 patients; 13.8 % had criteria of elevated left ventricular end-diastolic pressure; 17.5 % of patients had clinical signs of bronco-pulmonary pathology; 5.0 % had moderate and severe mitral regurgitation; 20 % displayed signs of chronotropic insufficiency during exercise including on the background of beta-blocker therapy; 15.0 % of patients displayed a hypertensive response to exercise, which was associated with signs of chronotropic insufficiency in 50 % of them; and 1.3 % had signs of hyperventilation syndrome. In addition to diagnosis of transient ischemia, additional information about the nature of shortness of breath was obtained for 72.5 % of patients. Based on results of the test, objective causes for dyspnea were not identified for 10.0 % of patients.Conclusion      The expanded stress-EchoCG protocol with exercise allows obtaining information about the nature of dyspnea for most patients with shortness of breath of a non-ischemic origin. For this patient category, expanding the stress-EchoCG protocol does not increase duration of the study and is economically beneficial for diagnosis of chronic heart failure and other causes for shortness of breath.


Assuntos
Ecocardiografia sob Estresse , Esforço Físico , Diástole , Dispneia/diagnóstico , Dispneia/etiologia , Teste de Esforço , Feminino , Humanos , Masculino , Função Ventricular Esquerda
2.
J Vis Exp ; (168)2021 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-33645572

RESUMO

Left ventricular (LV) dysfunction paves the final pathway for a multitude of cardiac disorders. With the non-invasive high-frequency transthoracic dobutamine stress echocardiography in humans, a reductionist investigation approach to unmask subtle changes in cardiac function has become possible. Here, we provide a protocol for using this technique in mice to facilitate expanded analysis of LV architecture and function in physiology and pathology enabling the observation of alterations in models of cardiac disease hidden in unstressed hearts. This investigation can be performed in one and the same animal and allows both, basal and pharmacologically stress-induced measurements. We outline detailed criteria for appropriate anesthesia, imaging-based LV analysis, consideration of intra- and interobserver variability, and obtaining positive inotrope response that can be attained in mice after intraperitoneal injection of dobutamine under near physiological conditions. To recapitulate the characteristics of human physiology and disease in small animal models, we highlight critical pitfalls in evaluation, e.g., a pronounced Bowditch effect in mice. To further meet translational objectives, we compare stress-induced effects in humans and mice. When used in translational studies, attention must be paid to physiological differences between mice and human. Experimental rigor dictates that some parameters assessed in patients can only be used with caution due to restrictions in spatial and temporal resolution in mouse models.


Assuntos
Dobutamina/farmacologia , Ecocardiografia sob Estresse , Coração/diagnóstico por imagem , Coração/fisiopatologia , Anestesia , Animais , Cardiopatias , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Camundongos Endogâmicos C57BL , Ultrassom
3.
Arq Bras Cardiol ; 116(2): 259-265, 2021 02.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33656074

RESUMO

BACKGROUND: Exertional dyspnea is a common complaint of patients with heart failure with preserved ejection fraction (HFpEF) and chronic obstructive pulmonary disease (COPD). HFpEF is common in COPD and is an independent risk factor for disease progression and exacerbation. Early detection, therefore, has great clinical relevance. OBJECTIVES: The aim of the study is to detect the frequency of masked HFpEF in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease, and to analyze the correlation between masked HFpEF and the cardiopulmonary exercise testing (CPET) parameters. METHODS: We applied the CPET in 104 non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. Echocardiography was performed before and at peak CPET. Cut-off values for stress-induced left and right ventricular diastolic dysfunction (LVDD/ RVDD) were E/e'>15; E/e'>6, respectively. Correlation analysis was done between CPET parameters and stress E/e'. A p-value <0.05 was considered significant. RESULTS: 64% of the patients had stress-induced LVDD; 78% had stress-induced RVDD. Both groups with stress LVDD and RVDD achieved lower load, lower V'O2 and O2-pulse, besides showing reduced ventilatory efficiency (higher VE/VCO2 slopes). None of the CPET parameters were correlated to stress-induced left or right E/e'. CONCLUSION: There is a high prevalence of stress-induced diastolic dysfunction in non-severe COPD patients with exertional dyspnea, free of overt cardiovascular disease. None of the CPET parameters correlates to stress-induced E/e'. This demands the performance of Exercise stress echocardiography (ESE) and CPET for the early detection and proper management of masked HFpEF in this population. (Arq Bras Cardiol. 2021; 116(2):259-265).


Assuntos
Insuficiência Cardíaca , Doença Pulmonar Obstrutiva Crônica , Ecocardiografia sob Estresse , Tolerância ao Exercício , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/diagnóstico por imagem , Volume Sistólico
4.
Eur J Clin Invest ; 51(4): e13509, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33548060

RESUMO

BACKGROUND: No data are available about whether Coronavirus disease 2019 (COVID-19) pandemic have led to changes in clinical profiles or results of exercise testing once the usual activity was reassumed, as well as if wearing a facemask has any impact on the tests. The aim of this study is to evaluate differences in the patients referred to exercise stress testing in the context of COVID-19 pandemic and analyse the feasibility and results of these tests wearing a facemask. METHODS: We included all patients referred for an exercise test from 1 June to 30 September 2020 and compared them with the patients attended within the same period in 2019 before and after propensity score matching. All patients referred in 2020 wore a facemask. RESULTS: A total of 854 patients were included: 398 in the 2020 group and 456 in 2019. No significant differences in baseline characteristics of the patients were observed, with the exception of dyspnoea, which was nearly twice as high in 2020 as compared with 2019. Regarding the results of the tests, no differences were observed, with almost 80% of maximal tests, similar functional capacity and over a 20% of positive exercise tests in both groups. These results remained after propensity score matching. CONCLUSION: COVID-19 pandemic has not changed the clinical profile of patients referred to exercise testing. In addition, performing exercise testing wearing a facemask is feasible, with no influence in functional capacity and clinical results.


Assuntos
/prevenção & controle , Ecocardiografia sob Estresse/métodos , Eletrocardiografia , Teste de Esforço/métodos , Máscaras , Isquemia Miocárdica/diagnóstico , Idoso , Tolerância ao Exercício , Feminino , Humanos , Masculino , Equivalente Metabólico , Pessoa de Meia-Idade , Isquemia Miocárdica/fisiopatologia , Desempenho Físico Funcional , Pontuação de Propensão , Encaminhamento e Consulta , Espanha
5.
Kardiologiia ; 60(12): 48-63, 2021 Jan 19.
Artigo em Russo | MEDLINE | ID: mdl-33522468

RESUMO

Diagnosis of heart failure with preserved ejection fraction (HFpEF) is associated with certain difficulties since many patients with HFpEF have a slight left ventricular diastolic dysfunction and normal filling pressure at rest. Diagnosis of HFpEF is improved by using diastolic transthoracic stress-echocardiography with dosed exercise (or diastolic stress test), which allows detection of increased filling pressure during the exercise. The present expert consensus explains the requirement for using the diastolic stress test in diagnosing HFpEF from clinical and pathophysiological standpoints; defines indications for the test with a description of its methodological aspects; and addresses issues of using the test in special patient groups.


Assuntos
Pesquisa Biomédica , Cardiologia , Insuficiência Cardíaca , Consenso , Ecocardiografia , Ecocardiografia sob Estresse , Teste de Esforço , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Federação Russa , Volume Sistólico , Função Ventricular Esquerda , Carga de Trabalho
7.
ABC., imagem cardiovasc ; 33(4): eabc110, 20200000.
Artigo em Português | LILACS | ID: biblio-1146299

RESUMO

Fundamento: Durante o ecocardiograma sob estresse com dobutamina, podem ocorrer efeitos adversos e exames inconclusivos. Objetivo: Avaliar em uma grande população geral a segurança e a exequibilidade do ecocardiograma sob estresse com dobutamina. Métodos: Estudo de 10.006 ecocardiogramas sob estresse com dobutamina realizados no período de julho de 1996 a setembro de 2007. A dobutamina foi administrada em quatro estágios (10, 20, 30 e 40 µcg.kg-1.min-1) para pesquisa de isquemia miocárdica e iniciada com 5 µcg.kg- ¹.min-1 apenas na análise de viabilidade miocárdica. A atropina foi iniciada conforme os protocolos vigentes. Foram verificados dados clínicos, hemodinâmicos e efeitos adversos associados ao ecocardiograma sob estresse com dobutamina. Resultados: Durante os ecocardiogramas sob estresse com dobutamina, ocorreu angina típica (8,9%), pico hipertensivo (1,7%), ectopias ventriculares isoladas (31%), taquiarritmia supraventricular (1,89%), fibrilação atrial (0,76%) e taquicardia ventricular não sustentada (0,6%). Os efeitos adversos citados foram mais frequentes nos pacientes com ecocardiogramas sob estresse com dobutamina positivos para isquemia. A desaceleração sinusal paradoxal (0,16%) não ocorreu em ecocardiogramas sob estresse com dobutamina positivo. As três complicações graves ocorreram em ecocardiogramas sob estresse com dobutamina positivos para isquemia. Foram dois casos (0,02%) com fibrilação ventricular e um caso de síndrome coronariana aguda (0,01%). Não houve caso de taquicardia ventricular sustentada, ruptura cardíaca, assistolia ou óbito. Comparados aos exames concluídos, nos inconclusivos, os pacientes usaram menos atropina (81,5% versus 49,9%; p< 0,001) e mais betabloqueador (4,7% versus 19%; p< 0,001), apresentando mais pico hipertensivo (1,1% versus 14,2%; p = 0,0001) e taquicardia ventricular não sustentada (0,5% versus 2,2%; p< 0,001). Conclusão: O ecocardiograma sob estresse com dobutamina realizado de forma apropriada é seguro e apresenta elevada exequibilidade.


Background: Adverse effects and inconclusive results may occur on dobutamine stress echocardiography. Objective: To assess the safety and feasibility of dobutamine stress echocardiography in a large general population. Methods: A total of 10,006 dobutamine stress echocardiographies were performed between July 1996 and September 2007. Dobutamine was administered in four stages (10, 20, 30, and 40 µcg·kg-1·min-1) to research myocardial ischemia starting with 5 µcg·kg- ¹·min-1 to analyze myocardial viability. Atropine administration was initiated according to current protocols. Clinical, hemodynamic, and adverse effect data associated with dobutamine stress echocardiography findings were verified. Results: Typical angina (8.9%), hypertensive peak (1.7%), isolated ventricular ectopias (31%), supraventricular tachyarrhythmia (1.89%), atrial


Assuntos
Humanos , Masculino , Feminino , Idoso , Doença das Coronárias/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Atropina/administração & dosagem , Estudos Retrospectivos , Fatores de Risco , Ecocardiografia sob Estresse/efeitos adversos , Ecocardiografia sob Estresse/efeitos dos fármacos , Dobutamina/administração & dosagem , Dobutamina/efeitos adversos , Eletrocardiografia/métodos , Hipertensão/complicações , Metoprolol/administração & dosagem
9.
Am Surg ; 86(8): 976-980, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32762469

RESUMO

BACKGROUND: Coronary artery disease (CAD) is a leading cause of mortality following orthotopic liver transplant, yet there is no standardized protocol for pre-liver-transplant coronary artery disease assessment. The main objective of this study was to determine the agreement between 2 methods of cardiac risk assessment: dobutamine stress echocardiogram (DSE) and coronary calcium score (CCS) and to determine which test was best able to predict coronary calcification in low-risk patients. METHODS: A retrospective study was performed using the medical records of 436 patients who received cardiac clearance for a liver transplant. A total of 152 patients' medical records were included based on the inclusion of patients who had received both DSE and CCS. A kappa coefficient was calculated to determine the agreement between the DSE and CCS results. In addition, the positive predictive values (PPVs) of both the CCS and DSE along with cardiac catheterization indicating abdominal occlusion were analyzed to compare the accuracy of the 2 tests. RESULTS: It was determined that there was a 12% agreement between DSE results and CCS. It was found that the DSE had a PPV of 56% and the CCS had a PPV of 80%. CONCLUSION: From this data, it was concluded that there was no agreement between the results of the CCS and the DSE. While neither the CCS nor the DSE presents an optimal method of risk assessment, the CCS had a much higher PPV and was therefore determined to be the more accurate test.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Transplante de Fígado , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Adulto , Idoso , Biomarcadores/metabolismo , Cálcio/metabolismo , Cateterismo Cardíaco , Regras de Decisão Clínica , Doença da Artéria Coronariana/etiologia , Doença da Artéria Coronariana/metabolismo , Ecocardiografia sob Estresse , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade
10.
Int J Cardiovasc Imaging ; 36(10): 1953-1962, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32757119

RESUMO

Negative stress echocardiography (NSE) is associated with low cardiovascular morbidity and overall mortality. We aimed to determine the clinical and echocardiographic predictors of overall and cardiovascular outcomes following NSE. Patients who underwent SE between 2013 and 2017 were reviewed. Patients with a history of solid organ transplant or being evaluated for transplant, history of end-stage renal or liver disease, and positive SE were excluded. NSE results were divided into negative diagnostic if patient reached target heart rate (THR) and had no wall motion abnormality (WMA) at rest or stress; negative non-diagnostic if patient had no WMA but did not reach THR or if image quality was non-diagnostic; and abnormal non-ischemic if patient had a resting WMA not worsened at stress along with a personal history of coronary artery disease (CAD). New CAD lesion at 1 year was defined as ≥ 50% stenosis on cardiac catheterization. Of 4119 patients with SE, 2575 were included. All-cause mortality rate was 1.1%/year and CAD rate was 3.1%/year. Predictors of all-cause mortality were age, male gender, history of smoking and being selected for dobutamine SE. Predictors of a new CAD lesion at 1 year were male gender, diabetes, personal history of CAD and abnormal non-ischemic SE. We identified clinical and echocardiographic characteristics in a subset of NSE patients who are at higher risk for subsequent adverse events. These characteristics should be accounted for during the clinical interpretation of SE, and patients found at increased risk for morbidity and mortality warrant continued follow-up.


Assuntos
Doença da Artéria Coronariana/diagnóstico por imagem , Ecocardiografia sob Estresse , Teste de Esforço , Agonistas de Receptores Adrenérgicos beta 1/administração & dosagem , Idoso , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/fisiopatologia , Dobutamina/administração & dosagem , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo
12.
Ter Arkh ; 92(4): 45-50, 2020 May 19.
Artigo em Russo | MEDLINE | ID: mdl-32598697

RESUMO

AIM: To compare diagnostic value between standard stress-echocardiography and myocardial contrast stress echocardiography in detection of myocardial ischemia in patients with different severity of coronary artery stenoses. MATERIALS AND METHODS: Myocardial contrast stress-echocardiography and standard stress-echocardiography were performed in 38 patients with coronary artery stenoses over 50% by angiography. Of all lesions 39 were intermediate (5075%) and 33 over 75% stenoses. Fractional flow reserve (FFR) was measured in 12 coronary arteries. During myocardial contrast stress-echocardiography wall motion and myocardial perfusion was assessed. RESULTS: Adequate visualisation increased from 81.6% in unenhanced segments to 96.1% in contrast-enhanced segments. The sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography in intermediate (5075%) coronary stenoses were 44%, 83%, 56% and 56%, 94% и 64% respectively compare to angiography. Taking into account the 12 arteries with evaluated FFR, these parameters increased to 52%, 93% и 65% in standard stress-echocardiography and to 68%, 100% and 75% in myocardial contrast stress-echocardiography. In coronary stenoses over 75% the sensitivity, specificity, and diagnostic accuracy of standard stress-echocardiography and myocardial contrast stress-echocardiography were 78%, 88%, 80% and 86%, 100%, 92% respectively Conclusion. Use of contrast-enhanced stress-echorardiography significantly increased the diagnostic value of this method by improving endocardial border visualization and possibilities of myocardial perfusion assessment.


Assuntos
Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Isquemia Miocárdica , Angiografia Coronária , Ecocardiografia , Ecocardiografia sob Estresse , Humanos , Sensibilidade e Especificidade
14.
Circ Heart Fail ; 13(6): e006769, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32543975

RESUMO

BACKGROUND: Patients with heart failure (HF) with preserved ejection fraction (HFpEF) typically develop dyspnea and pulmonary congestion upon exercise. Lung ultrasound is a simple diagnostic tool, providing semiquantitative assessment of extravascular lung water through B-lines. It has been shown that patients with HFpEF develop B-lines upon submaximal exercise stress echocardiography; however, whether exercise-induced pulmonary congestion carries prognostic implications is unknown. This study aimed at evaluating the prognostic value of B-line assessment during exercise in patients with HFpEF. METHODS: Sixty-one New York Heart Association class I to II patients with HFpEF underwent standard echocardiography, lung ultrasound (28-scanning point method), and BNP (B-type natriuretic peptide) assessment during supine exercise echocardiography (baseline and peak exercise). The primary end point was a composite of cardiovascular death or HF hospitalization at 1 year. RESULTS: B-lines, E/e', and BNP significantly increased during exercise (P<0.001 for all). By multivariable analysis, both peak (hazard ratio, 1.50 [95% CI, 1.21-1.85], P<0.001), and change (hazard ratio 1.34 [95% CI, 1.12-1.62], P=0.002) B-lines were retained as independent predictors of outcome (hazard ratios per 1 B-line increment), along with BNP and E/e' ratio. Importantly, adding peak B-line on top of a clinical model significantly improved prognostic accuracy (C-index increase, 0.157 [0.056-0.258], P=0.002) and net reclassification (continuous net reclassification improvement, 0.51 [0.09-0.74], P=0.016), with similar results for B-line change. CONCLUSIONS: Detection of exercise-induced pulmonary congestion by lung ultrasound is an independent predictor of outcome in patients with HFpEF; its use may help refining the routine risk stratification of these patients on top of well-established clinical variables.


Assuntos
Ecocardiografia Doppler , Ecocardiografia sob Estresse , Teste de Esforço , Insuficiência Cardíaca/diagnóstico por imagem , Pulmão/irrigação sanguínea , Pulmão/diagnóstico por imagem , Circulação Pulmonar , Edema Pulmonar/diagnóstico por imagem , Volume Sistólico , Função Ventricular Esquerda , Idoso , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Edema Pulmonar/mortalidade , Edema Pulmonar/fisiopatologia , Edema Pulmonar/terapia , Fatores de Tempo
15.
Heart Fail Clin ; 16(3): 347-355, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32503757

RESUMO

The key to understanding hemodynamics in heart failure (HF) is the relation between elevated left ventricular (LV) filling pressure and cardiac output. Some patients show abnormal response to stress in the relationship between LV filling pressure and cardiac output. In patients with preserved diastolic function, cardiac output can be increased without significantly elevated filling pressure during stress. In patients with HF, as long as the Frank-Starling mechanism operates effectively, cardiac output can increase while acquiring elevated filling pressure. In patients with decompensated HF, hemodynamic stress will lead to a much greater elevation in filling pressure and pulmonary venous hypertension.


Assuntos
Gerenciamento Clínico , Ecocardiografia sob Estresse/métodos , Insuficiência Cardíaca , Débito Cardíaco , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Hemodinâmica , Humanos
16.
Int J Cardiovasc Imaging ; 36(9): 1647-1656, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32350703

RESUMO

Non-invasive myocardial work (MW) indices are superior to global longitudinal strain (GLS) to assess left ventricular (LV) mechanics in situations where afterload is abnormally high. The rotational motion of the apex provides an accurate index of LV contractility. To date, there are no data about MW values during stress echocardiography (SE), particularly for the apex. Our study aims at assessing MW indices at peak exercise to better understand LV mechanics in patients with high peak systolic blood pressure (SBP). A total of 81 patients without structural or ischemic heart disease referred for SE between January and June 2019 were included. BP measurements, GLS and MW indices were performed at rest and peak exercise. In order to quantify the role of the apex, apical work fraction (AWF) was also calculated and further stratified by peak SBP. A peak SBP > 180 mmHg was considered abnormally high. There were 36 (44%) patients who had peak SBP > 180 mmHg. They showed similar resting GLS and MW values when compared to control. However, peak stress global work index, constructive work and wasted work (GWW) increased significantly (P-value < 0.05), with a relatively constant global work efficiency. In the multivariate analysis, peak SBP > 180 mmHg was associated with threefold increased odds of abnormal peak GWW > 96.5 mmHg% (median value) (odds ratio 3.0, P-value 0.003). Apical work increased significantly when stratified by peak SBP (P-value 0.003) and AWF increased from 33 ± 3% to 37 ± 3% (rest-stress), P-value < 0.0001, but remained constant when stratified by peak SBP. Our analysis provides new data on MW indices at peak stress, particularly for patients with abnormal peak SBP response, and supports the role and the contribution of the apex to MW.


Assuntos
Pressão Sanguínea , Ecocardiografia sob Estresse , Teste de Esforço , Contração Miocárdica , Função Ventricular Esquerda , Adaptação Fisiológica , Adulto , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Tempo
17.
Am Heart J ; 224: 156-165, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32402702

RESUMO

BACKGROUND: Although the need to detect restenosis has diminished in the contemporary practice of percutaneous coronary intervention (PCI) with drug-eluting stents (DES), the surveillance of ischemia owing to restenosis or disease progression deserves attention in high-risk PCI settings. It is unknown whether follow-up strategy of routine noninvasive functional testing potentially reduces the risk of major cardiovascular events in high-risk PCI patients. METHODS: The POST-PCI study is an investigator-initiated, multicenter, prospective randomized trial comparing the effectiveness of two follow-up strategies in patients with high-risk anatomic or clinical characteristics who underwent PCI. Study participants were randomly assigned to either (1) the routine noninvasive stress testing (exercise electrocardiography, nuclear stress imaging, or stress echocardiography) at 12 months post-PCI or (2) the standard-care without routine testing. In the routine stress testing group, depending on the testing results, all clinical decisions regarding subsequent diagnostic or therapeutic procedures were at the treating physician's discretion. The primary endpoint was a composite outcome of death from any causes, myocardial infarction, or hospitalization for unstable angina at 2 years post-PCI. RESULTS: More than 1700 high-risk PCI patients have been randomized over 2.0 years at 11 major cardiac centers in Korea. CONCLUSION: This pragmatic POST-PCI trial will provide valuable clinical evidence on the effectiveness of follow-up strategy of routine noninvasive stress testing in high-risk PCI patients.


Assuntos
Doença da Artéria Coronariana/cirurgia , Reestenose Coronária/diagnóstico , Stents Farmacológicos , Ecocardiografia sob Estresse/métodos , Eletrocardiografia , Intervenção Coronária Percutânea/métodos , Sistema de Registros , Idoso , Doença da Artéria Coronariana/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Reoperação
18.
Int J Cardiovasc Imaging ; 36(10): 1845-1853, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32458290

RESUMO

Mitral annular calcification (MAC) is increasingly encountered, particularly among the elderly and those with chronic kidney disease, and is often associated with a transvalvular gradient. In contrast to rheumatic mitral stenosis relatively little is known about mitral stenosis due to MAC. We aimed to clarify whether exercise limitation in this group is primarily due to valvular obstruction or ventricular dysfunction resulting from multiple comorbidities. 20 patients with severe MAC (bulky calcium deposits which restricted leaflet motion) were submitted to supine bicycle exercise, measuring Doppler and echocardiographic parameters at baseline and during exercise. They were compared 1:1 to subjects matched for age, sex, and left ventricular wall thickness. At baseline MAC subjects had higher mean mitral valve gradients (MVG) than comparison subjects (7.5 ± 3.8 vs 1.6 ± 0.8 mm Hg, p < 0.0001), along with larger indexed left atrial volumes (54.4 ± 14.9 vs 34.0 ± 11.7 mL, p < 0.0001) and reduced left atrial strains (reservoir, conduit, and booster pump). With exercise MAC subjects reached higher levels of MVG (17.3 ± 8.4 vs 5.5 ± 2.5 mm Hg, p < 0.0001), and pulmonary artery systolic pressure (estimated from tricuspid regurgitant jet [TR] velocity) and displayed a moderate correlation between ΔMVG and ΔTR velocity (r2 = 0.57). MAC subjects whose exercise MVG was ≥ 15 mm Hg all had a peak pulmonary artery systolic pressure > 60 mm Hg. MAC subjects also had relative chronotropic incompetence. Patients with severe MAC and a transvalvular gradient experience large increases in MVG and pulmonary pressure with exercise, similar to what has been described in rheumatic mitral stenosis. MAC may be an under-recognized cause of dyspnea and exercise intolerance in older patients.


Assuntos
Calcinose/diagnóstico por imagem , Ecocardiografia Doppler , Ecocardiografia sob Estresse , Teste de Esforço , Tolerância ao Exercício , Hemodinâmica , Estenose da Valva Mitral/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Idoso , Ciclismo , Calcinose/complicações , Calcinose/fisiopatologia , Estudos de Casos e Controles , Dispneia/etiologia , Dispneia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/fisiopatologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de Tempo
19.
Int J Cardiovasc Imaging ; 36(10): 1831-1843, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32462450

RESUMO

Noninvasive estimation of systolic pulmonary artery pressure (SPAP) during exercise stress echocardiography (ESE) is recommended for pulmonary hemodynamics evaluation but remains flow-dependent. Our aim was to assess the feasibility of pulmonary vascular reserve index (PVRI) estimation during ESE combining SPAP with cardiac output (CO) or exercise-time and compare its value in three group of patients: with invasively confirmed pulmonary hypertension (PH), at risk of PH development (PH risk) mainly with systemic sclerosis and in controls (C) without clinical risk factors for PH, age-matched with PH risk patients. We performed semisupine ESE in 171 subjects: 31 PH, 61 PH at risk and 50 controls as well as in 29 young, healthy normals. Rest and stress assessment included: tricuspid regurgitant flow velocity (TRV), pulmonary acceleration time (ACT), CO (Doppler-estimated). SPAP was calculated from TRV or ACT when TRV was not available. We estimated PVRI based on CO (peak CO/SPAP*0.1) or exercise-time (ESE time/SPAP*0.1). During stress, TRV was measurable in 44% patients ACT in 77%, either one in 95%. PVRI was feasible in 65% subjects with CO and 95% with exercise-time (p < 0.0001). PVRI was lower in PH compared to controls both for CO-based PVRI (group 1 = 1.0 ± 0.95 vs group 3 = 4.28 ± 2.3, p < 0.0001) or time-based PVRI estimation (0.66 ± 0.39 vs 3.95 ± 2.26, p < 0.0001). The proposed criteria for PH detection were for CO-based PVRI ≤ 1.29 and ESE-time based PVRI ≤ 1.0 and for PH risk ≤ 1.9 and ≤ 1.7 respectively. Noninvasive estimation of PVRI can be obtained in near all patients during ESE, without contrast administration, integrating TRV with ACT for SPAP assessment and using exercise time as a proxy of CO. These indices allow for comparison of pulmonary vascular dynamics in patients with varied exercise tolerance and clinical status.


Assuntos
Ecocardiografia Doppler , Ecocardiografia sob Estresse , Teste de Esforço , Hemodinâmica , Hipertensão Pulmonar/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Circulação Pulmonar , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Arterial , Débito Cardíaco , Estudos de Casos e Controles , Europa (Continente) , Tolerância ao Exercício , Estudos de Viabilidade , Feminino , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Pulmonar/fisiopatologia , Fatores de Tempo , Adulto Jovem
20.
Int J Cardiovasc Imaging ; 36(9): 1679-1688, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32367187

RESUMO

To analyze left ventricular myocardial deformation and contractile reserve in endurance athletes at rest and during exercise, and their possible correlations with functional capacity. The athlete's heart in endurance training is characterized by physiologic eccentric remodeling, with left ventricle adaptation at rest and echocardiographic parameters at low end of normality. Assessment of left ventricle systolic function and contractile reserve has an important role in the decision-making and in differential diagnosis with cardiomyopathies. Standard echo, lung ultrasound, left ventricle 2D speckle-tracking strain and myocardial work were performed at rest and during exercise in endurance athletes and in age- and sex-comparable healthy controls. 350 endurance athletes (male sex 58.5%; 31.6 ± 4.2 years) and 150 healthy controls were enrolled. Left ventricular ejection fraction at baseline was comparable between the two groups. Resting left ventricular global longitudinal strain was reduced in endurance athletes (- 18.4 ± 2.6% vs. - 22.4 ± 3.3% in controls; p < 0.01). Myocardial work efficiency did not show significative difference between the two groups. At peak exertion during exercise stress echocardiography, endurance athletes showed better exercise capacity and peak VO2 consumption (58.6 ± 10.2 ml/kg/min vs 38.6 ± 3.3 ml/kg/min in controls, p < 0.0001), associated with a preserved contractile reserve and augmented pulmonary artery systolic pressure. By multivariable analysis myocardial work efficiency at rest was closely related to maximal watts (p < 0.0001), peak VO2, (p < 0.0001), left ventricular E/e' (p < 0.001) and number of B-lines (p < 0.001), all measured at peak effort. Myocardial work efficiency shows less load-dependency than global longitudinal strain. Normal resting values of myocardial work efficiency in endurance athletes suggest a physiological remodeling, associated with a better exercise capacity and preserved contractile reserve during physical effort.


Assuntos
Atletas , Ecocardiografia Doppler , Ecocardiografia sob Estresse , Teste de Esforço , Ventrículos do Coração/diagnóstico por imagem , Contração Miocárdica , Resistência Física , Tinha dos Pés , Função Ventricular Esquerda , Remodelação Ventricular , Adulto , Estudos de Casos e Controles , Tolerância ao Exercício , Feminino , Humanos , Masculino , Variações Dependentes do Observador , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Volume Sistólico , Fatores de Tempo
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