Bicycle stress echocardiography revealed that left and right ventricular reserve were significantly reduced in HFpEF patients compared to healthy controls (P≤0.01 for interaction across groups).
Cross-Sectional (n=53)
Does bicycle stress echocardiography reveal differences in biventricular contractile reserve across the spectrum of diastolic dysfunction and HFpEF?
Exercise stress echocardiography unmasks impaired biventricular contractile reserve and RV-pulmonary artery uncoupling in HFpEF and preclinical diastolic dysfunction, highlighting its potential for early diagnosis.
p-value: p=≤ 0.01
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.
Claeys et al. (2022) conducted a cross-sectional in Heart failure with preserved ejection fraction (HFpEF) (n=53). Heart failure with preserved ejection fraction (HFpEF) and asymptomatic diastolic dysfunction vs. Healthy controls was evaluated on Ventricular performance during exercise (p=≤ 0.01). Bicycle stress echocardiography revealed that left and right ventricular reserve were significantly reduced in HFpEF patients compared to healthy controls (P≤0.01 for interaction across groups).