Erwan Donal1, Lars H Lund2, Emmanuel Oger3, Amélie Reynaud4, Frédéric Schnell4, Hans Persson5, Elodie Drouet6, Cecilia Linde2, Claude Daubert7. 1. Cardiologie, CHU Rennes, Rennes, France CIC-IT 804, LTSI INSERM 1099, Université Rennes-1, Hôpital Pontchaillou, rue Henri Le Guillou, F-35000 Rennes, France erwan.donal@chu-rennes.fr. 2. Pharmacologie Clinique et CIC-IP 0203, CHU Rennes et Université Rennes-1, Rennes, France. 3. Karolinska University Hospital Stockholm, Solna, Sweden. 4. CIC-IT 804, LTSI INSERM 1099, Université Rennes-1, Hôpital Pontchaillou, rue Henri Le Guillou, F-35000 Rennes, France. 5. Danderyds Hospital, Stockholm, Sweden. 6. Cellule recherche clinique et registres, Société Française de Cardiologie et URC Paris Est, Paris, France. 7. Cardiologie, CHU Rennes, Rennes, France CIC-IT 804, LTSI INSERM 1099, Université Rennes-1, Hôpital Pontchaillou, rue Henri Le Guillou, F-35000 Rennes, France.
Abstract
BACKGROUND: KaRen is a multicentre study designed to characterize and follow patients with heart failure and preserved ejection fraction (HFpEF). In a subgroup of patients with clinical signs of congestion but left ventricular ejection fraction (LVEF) >45%, we sought to describe and analyse the potential prognostic value of echocardiographic parameters recorded not only at rest but also during a submaximal exercise stress echocardiography. Exercise-induced changes in echo parameters might improve our ability to characterize HFpEF patients. METHOD AND RESULTS: Patients were prospectively recruited in a single tertiary centre following an acute HF episode with NT-pro-BNP >300 pg/mL (BNP > 100 pg/mL) and LVEF > 45% and reassessed by exercise echo-Doppler after 4-8 weeks of dedicated treatment. Image acquisitions were standardized, and analysis made at end of follow-up blinded to patients' clinical status and outcome. In total, 60 patients having standardized echocardiographic acquisitions were included in the analysis. Twenty-six patients (43%) died or were hospitalized for HF (primary outcome). The mean ± SD workload was 45 ± 14 watts (W). Mean ± SD resting LVEF and LV global longitudinal strain was 57.6 ± 9.5% and -14.5 ± 4.2%, respectively. Mean ± SD resting E/e' was 11.3 ± 4.7 and 13.1 ± 5.3 in those patients who did not and those who did experience the primary outcome, respectively (P = 0.03). Tricuspid regurgitation (TR) peak velocity during exercise were 3.3 ± 0.5 and 3.7 ± 0.5 m/s (P = 0.01). Exercise TR was independently associated with HF-hospitalization or death after adjustment on baseline clinical and biological characteristics. CONCLUSION: Exercise echocardiography may contribute to identify HFpEF patients and especially high-risk ones. Our study suggested a prognostic value of TR recorded during an exercise. That was demonstrated independently of the value of resting E/e'. Published on behalf of the European Society of Cardiology. All rights reserved.
BACKGROUND: KaRen is a multicentre study designed to characterize and follow patients with heart failure and preserved ejection fraction (HFpEF). In a subgroup of patients with clinical signs of congestion but left ventricular ejection fraction (LVEF) >45%, we sought to describe and analyse the potential prognostic value of echocardiographic parameters recorded not only at rest but also during a submaximal exercise stress echocardiography. Exercise-induced changes in echo parameters might improve our ability to characterize HFpEF patients. METHOD AND RESULTS:Patients were prospectively recruited in a single tertiary centre following an acute HF episode with NT-pro-BNP >300 pg/mL (BNP > 100 pg/mL) and LVEF > 45% and reassessed by exercise echo-Doppler after 4-8 weeks of dedicated treatment. Image acquisitions were standardized, and analysis made at end of follow-up blinded to patients' clinical status and outcome. In total, 60 patients having standardized echocardiographic acquisitions were included in the analysis. Twenty-six patients (43%) died or were hospitalized for HF (primary outcome). The mean ± SD workload was 45 ± 14 watts (W). Mean ± SD resting LVEF and LV global longitudinal strain was 57.6 ± 9.5% and -14.5 ± 4.2%, respectively. Mean ± SD resting E/e' was 11.3 ± 4.7 and 13.1 ± 5.3 in those patients who did not and those who did experience the primary outcome, respectively (P = 0.03). Tricuspid regurgitation (TR) peak velocity during exercise were 3.3 ± 0.5 and 3.7 ± 0.5 m/s (P = 0.01). Exercise TR was independently associated with HF-hospitalization or death after adjustment on baseline clinical and biological characteristics. CONCLUSION: Exercise echocardiography may contribute to identify HFpEF patients and especially high-risk ones. Our study suggested a prognostic value of TR recorded during an exercise. That was demonstrated independently of the value of resting E/e'. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: T Jake Samuel; Rhys Beaudry; Mark J Haykowsky; Satyam Sarma; Suwon Park; Thomas Dombrowsky; Paul S Bhella; Michael D Nelson Journal: Clin Cardiol Date: 2017-12-16 Impact factor: 2.882
Authors: Eugenio Picano; Quirino Ciampi; Rodolfo Citro; Antonello D'Andrea; Maria Chiara Scali; Lauro Cortigiani; Iacopo Olivotto; Fabio Mori; Maurizio Galderisi; Marco Fabio Costantino; Lorenza Pratali; Giovanni Di Salvo; Eduardo Bossone; Francesco Ferrara; Luna Gargani; Fausto Rigo; Nicola Gaibazzi; Giuseppe Limongelli; Giuseppe Pacileo; Maria Grazia Andreassi; Bruno Pinamonti; Laura Massa; Marco A R Torres; Marcelo H Miglioranza; Clarissa Borguezan Daros; José Luis de Castro E Silva Pretto; Branko Beleslin; Ana Djordjevic-Dikic; Albert Varga; Attila Palinkas; Gergely Agoston; Dario Gregori; Paolo Trambaiolo; Sergio Severino; Ayana Arystan; Marco Paterni; Clara Carpeggiani; Paolo Colonna Journal: Cardiovasc Ultrasound Date: 2017-01-18 Impact factor: 2.062
Authors: Evgeny Belyavskiy; Daniel A Morris; Marion Url-Michitsch; Nicolas Verheyen; Andreas Meinitzer; Aravind-Kumar Radhakrishnan; Martin Kropf; Athanasios Frydas; Artem G Ovchinnikov; Albrecht Schmidt; Marijana Tadic; Martin Genger; Ruhdja Lindhorst; Anna Bobenko; Carsten Tschöpe; Frank Edelmann; Elisabeth Pieske-Kraigher; Burkert Pieske Journal: ESC Heart Fail Date: 2018-11-19