During exercise stress echocardiography, HFrEF patients showed absent contractile reserve, while HFpEF patients exhibited a blunted increase in constructive work and abnormal wasted work compared to controls.
Cross-Sectional (n=24)
Does myocardial work analysis during semi-supine stress echocardiography reveal distinct exercise response patterns between heart failure patients (HFrEF and HFpEF) and healthy controls?
Myocardial work analysis during stress echocardiography can differentiate heart failure phenotypes by revealing distinct patterns of systolic and diastolic reserve compared to healthy controls.
Abstract Background Myocardial response to exercise and its differences between heart failure with reduced (HFrEF) and preserved ejection fraction (HFpEF) remain incompletely understood. Myocardial work (MyW) enables a non-invasive assessment of left ventricular performance under physiological stress. We investigated exercise-induced MyW responses in patients with chronic heart failure and healthy controls. Methods and results MyStress Pilot study enrolled 24 individuals (12 chronic heart failure patients (6 HFrEF, 6 HFpEF) and 12 healthy controls), aged 40–80 years, who underwent semi-supine exercise stress echocardiography (ESE) using a standardized protocol up to 75 Watt. MyW indices (global work index GWI, global constructive work GCW, global wasted work GWW, global work efficiency GWE) were derived using pressure-strain analysis. Linear mixed-effects models assessed workload-dependent changes. Patients with HFrEF and HFpEF were older and achieved lower peak workloads than controls. At rest, GCW was reduced in HFrEF, while GWW was elevated in both heart failure groups. During exercise, controls demonstrated substantial increases in GCW and GWI. In contrast, HFrEF patients showed exhibited little or no augmentation of GCW and GWI, indicating absent contractile reserve, whereas HFpEF patients showed a blunted increase in GCW accompanied by an abnormal increase in GWW. These differences persisted despite similar systolic blood pressure trajectories across groups, indicating that altered MyW responses were not simply due to afterload. Diastolic parameters increased steeply in HFpEF, unmasking impaired diastolic reserve. Conclusion MyW analysis during ESE revealed distinct systolic and diastolic response patterns in heart failure phenotypes and controls. These findings illustrate how pressure-strain analysis can enrich ESE beyond conventional metrics.
Sahiti et al. (Thu,) conducted a cross-sectional in Chronic heart failure (n=24). Heart failure (HFrEF and HFpEF) vs. Healthy controls was evaluated on Exercise-induced myocardial work responses (GWI, GCW, GWW, GWE). During exercise stress echocardiography, HFrEF patients showed absent contractile reserve, while HFpEF patients exhibited a blunted increase in constructive work and abnormal wasted work compared to controls.