Clinical InvestigationExercise EchocardiographyCardiac Reserve and Exercise Capacity: Insights from Combined Cardiopulmonary and Exercise Echocardiography Stress Testing
Section snippets
Study Population
We prospectively enrolled 465 consecutive patients referred for dyspnea to the University Hospital of Pisa between September 2017 and February 2020 (Figure 1). All patients fell within the ACC/AHA HF stage A (asymptomatic subjects with cardiovascular risk factors), stage B (structural heart disease without signs or symptoms of HF), or stage C (clinically overt HF). Arterial hypertension (AH) was defined by the presence of at least two BP recordings >140/90 mm Hg or treatment with
Study Population
Demographic and clinical characteristics of the population are shown in Table 1. There were no significant differences in terms of age and sex between patient subgroups. Individuals in stage A-B had the largest body mass index and the highest prevalence of AH, dyslipidemia, and diabetes mellitus; stage C patients showed the highest prevalence of CKD, but there were no patients receiving dialysis. Stage C HFrEF profile was characterized by coronary artery disease with its complications and
Discussion
Peak VO2 during exercise is directly related to measures of LV and LA function and RV-PA coupling, in addition to central components of the Fick principle (i.e., HR and SV) and independently of workload, age, and sex. The evaluation of cardiac mechanics using an integrated CPET-ESE approach provides valuable knowledge about the factors that may determine effort intolerance across the spectrum of HF, above and beyond insights assessed only in resting conditions. We summarized in Figure 5 the
Conclusion
The necessity of studying multiple aspects of the cardiovascular system is growing strong to fill the gaps in HF management, mainly for HFpEF and subjects at risk of developing it.34,35 A functional model including different aspects of cardiac function may enable more mechanistic insight into the nature of VO2 impairment during exercise. The measurement of HR, SV, LV contractility, LA compliance, and RV-PA coupling is feasible in a combined CPET-ESE approach and can identify different causes of
References (35)
- et al.
Cardiopulmonary exercise testing: what is its value?
JACC
(2017) - et al.
Stressing the cardiopulmonary vascular system: the role of echocardiography
J Am Soc Echocardiogr
(2018) - et al.
Left atrial function dynamics during exercise in heart failure: pathophysiological implications on the right heart and exercise ventilation inefficiency
JACC Cardiovasc Imaging
(2017) - et al.
Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
J Am Soc Echocardiogr
(2015) - et al.
Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
J Am Soc Echocardiogr
(2016) - et al.
The added value of exercise stress echocardiography in patients with heart failure
Am J Cardiol
(2019) - et al.
Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction
J Am Coll Cardiol
(2010) Left atrial size and function: role in prognosis
J Am Coll Cardiol
(2014)- et al.
Limited maximal exercise capacity in patients with chronic heart failure: partitioning the contributors
J Am Coll Cardiol
(2010) - et al.
Hemodynamic correlates and diagnostic role of cardiopulmonary exercise testing in heart failure with preserved ejection fraction
JACC Heart Fail
(2018)
Arterial stiffening with exercise in patients with heart failure and preserved ejection fraction
J Am Coll Cardiol
Heart failure with mid-range (borderline) ejection fraction: clinical implications and future directions
JACC Heart Fail
Haemodynamic and metabolic phenotyping of hypertensive patients with and without heart failure by combining cardiopulmonary and echocardiographic stress test
Eur J Heart Fail
Value of combined cardiopulmonary and echocardiography stress test to characterize the haemodynamic and metabolic responses of patients with heart failure and mid-range ejection fraction
Eur Heart J Cardiovasc Imaging
Left atrial strain and compliance in the diagnostic evaluation of heart failure with preserved ejection fraction
Eur J Heart Fail
Echo-derived peak cardiac power output-to-left ventricular mass with cardiopulmonary exercise testing predicts outcome in patients with heart failure and depressed systolic function
Eur Heart J Cardiovasc Imaging
Preload, contractility, and afterload as determinants of stroke volume during elevation of aortic blood pressure in dogs
Cardiovasc Res
Cited by (0)
The last two authors should be considered the same in author order.
Conflicts of Interest: None.