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Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study.
ESC Heart Fail. 2019 02; 6(1):146-153.EH

Abstract

AIMS

The purpose of this pilot study was to assess the potential usefulness of diastolic stress test (DST) echocardiography in patients with suspected heart failure with preserved ejection fraction (HFpEF).

METHODS AND RESULTS

Patients with suspected HFpEF (left ventricular ejection fraction ≥ 50%, exertional dyspnoea, septal E/e' at rest 9-14, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) at rest < 220 pg/mL; n = 13) and a control group constituted from asymptomatic patients with arterial hypertension (n = 19) and healthy subjects (n = 18) were included. All patients were analysed by two-dimensional and Doppler echocardiography at rest and during exercise (DST) and underwent cardiopulmonary exercise testing and NT-proBNP analysis during exercise. HFpEF during exercise was defined as exertional dyspnoea and peak VO2 ≤ 20.0 mL/min/kg. In patients with suspected HFpEF at rest, 84.6% of these patients developed HFpEF during exercise, whereas in the group of asymptomatic patients with hypertension and healthy subjects, the rate of developed HFpEF during exercise was 0%. Regarding the diagnostic performance of DST to detect HFpEF during exercise, an E/e' ratio >15 during exercise was the most accurate parameter to detect HFpEF (accuracy 86%), albeit a low sensitivity (45.5%). Nonetheless, combining E/e' with tricuspid regurgitation (TR) velocity > 2.8 m/s during exercise provided a significant increase in the sensitivity to detect patients with HFpEF during exercise (sensitivity 72.7%, specificity 79.5%, and accuracy 78%). Consistent with these findings, an increase of E/e' was significantly linked to worse peak VO2 , and the combination of an increase of both E/e' and TR velocity was associated with elevated NT-proBNP values during exercise.

CONCLUSIONS

The findings of this pilot study suggest that DST using E/e' ratio and TR velocity could be of potential usefulness to diagnose HFpEF during exercise in patients with suspected HFpEF at rest.

Authors+Show Affiliations

Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.Department of Cardiology, Medical University Graz, Graz, Austria.Department of Cardiology, Medical University Graz, Graz, Austria.Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. AIT Austrian Institute of Technology, Graz, Austria.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. Berlin Institute of Health (BIH), Berlin, Germany.Out-Patient Department, Institute of Clinical Cardiology of A.L.Myasnikov, National Medical Research Center of Cardiology of Ministry of Healthcare of the Russian Federation, Moscow, Russia.Department of Cardiology, Medical University Graz, Graz, Austria.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. Department of Cardiology and Intensive Care Medicine, LKH Graz Süd-West, Graz, Austria.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany. Berlin Institute of Health (BIH), Berlin, Germany.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany. Charité, Berlin Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK), Berlin, Germany.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany. Berlin Institute of Health (BIH), Berlin, Germany.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany. German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany. Berlin Institute of Health (BIH), Berlin, Germany. Department of Internal Medicine and Cardiology German Heart Center Berlin, Berlin, Germany.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30451399

Citation

Belyavskiy, Evgeny, et al. "Diastolic Stress Test Echocardiography in Patients With Suspected Heart Failure With Preserved Ejection Fraction: a Pilot Study." ESC Heart Failure, vol. 6, no. 1, 2019, pp. 146-153.
Belyavskiy E, Morris DA, Url-Michitsch M, et al. Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study. ESC Heart Fail. 2019;6(1):146-153.
Belyavskiy, E., Morris, D. A., Url-Michitsch, M., Verheyen, N., Meinitzer, A., Radhakrishnan, A. K., Kropf, M., Frydas, A., Ovchinnikov, A. G., Schmidt, A., Tadic, M., Genger, M., Lindhorst, R., Bobenko, A., Tschöpe, C., Edelmann, F., Pieske-Kraigher, E., & Pieske, B. (2019). Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study. ESC Heart Failure, 6(1), 146-153. https://doi.org/10.1002/ehf2.12375
Belyavskiy E, et al. Diastolic Stress Test Echocardiography in Patients With Suspected Heart Failure With Preserved Ejection Fraction: a Pilot Study. ESC Heart Fail. 2019;6(1):146-153. PubMed PMID: 30451399.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diastolic stress test echocardiography in patients with suspected heart failure with preserved ejection fraction: a pilot study. AU - Belyavskiy,Evgeny, AU - Morris,Daniel A, AU - Url-Michitsch,Marion, AU - Verheyen,Nicolas, AU - Meinitzer,Andreas, AU - Radhakrishnan,Aravind-Kumar, AU - Kropf,Martin, AU - Frydas,Athanasios, AU - Ovchinnikov,Artem G, AU - Schmidt,Albrecht, AU - Tadic,Marijana, AU - Genger,Martin, AU - Lindhorst,Ruhdja, AU - Bobenko,Anna, AU - Tschöpe,Carsten, AU - Edelmann,Frank, AU - Pieske-Kraigher,Elisabeth, AU - Pieske,Burkert, Y1 - 2018/11/19/ PY - 2018/05/09/received PY - 2018/09/07/revised PY - 2018/10/10/accepted PY - 2018/11/20/pubmed PY - 2019/3/16/medline PY - 2018/11/20/entrez KW - Diastolic stress test KW - Exercise echocardiography KW - Exertional dyspnoea KW - Heart failure with preserved ejection fraction SP - 146 EP - 153 JF - ESC heart failure JO - ESC Heart Fail VL - 6 IS - 1 N2 - AIMS: The purpose of this pilot study was to assess the potential usefulness of diastolic stress test (DST) echocardiography in patients with suspected heart failure with preserved ejection fraction (HFpEF). METHODS AND RESULTS: Patients with suspected HFpEF (left ventricular ejection fraction ≥ 50%, exertional dyspnoea, septal E/e' at rest 9-14, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) at rest < 220 pg/mL; n = 13) and a control group constituted from asymptomatic patients with arterial hypertension (n = 19) and healthy subjects (n = 18) were included. All patients were analysed by two-dimensional and Doppler echocardiography at rest and during exercise (DST) and underwent cardiopulmonary exercise testing and NT-proBNP analysis during exercise. HFpEF during exercise was defined as exertional dyspnoea and peak VO2 ≤ 20.0 mL/min/kg. In patients with suspected HFpEF at rest, 84.6% of these patients developed HFpEF during exercise, whereas in the group of asymptomatic patients with hypertension and healthy subjects, the rate of developed HFpEF during exercise was 0%. Regarding the diagnostic performance of DST to detect HFpEF during exercise, an E/e' ratio >15 during exercise was the most accurate parameter to detect HFpEF (accuracy 86%), albeit a low sensitivity (45.5%). Nonetheless, combining E/e' with tricuspid regurgitation (TR) velocity > 2.8 m/s during exercise provided a significant increase in the sensitivity to detect patients with HFpEF during exercise (sensitivity 72.7%, specificity 79.5%, and accuracy 78%). Consistent with these findings, an increase of E/e' was significantly linked to worse peak VO2 , and the combination of an increase of both E/e' and TR velocity was associated with elevated NT-proBNP values during exercise. CONCLUSIONS: The findings of this pilot study suggest that DST using E/e' ratio and TR velocity could be of potential usefulness to diagnose HFpEF during exercise in patients with suspected HFpEF at rest. SN - 2055-5822 UR - https://www.unboundmedicine.com/medline/citation/30451399/Diastolic_stress_test_echocardiography_in_patients_with_suspected_heart_failure_with_preserved_ejection_fraction:_a_pilot_study_ L2 - https://doi.org/10.1002/ehf2.12375 DB - PRIME DP - Unbound Medicine ER -