Key result
The novel CPET-hiESE protocol yielded better data completeness for right ventricle strain compared with standard maximal ESE (71.4% and 76.2% vs. 42.9%, P=0.07) at lower levels of exertion.
Why the study?
CPET and ESE are valuable in managing cardiac disease, but no standard combined CPET-ESE protocol is currently recommended.
Does a new high-intensity single-stage combined CPET-ESE protocol improve feasibility and provide comparable cardiac function responses compared to standard maximal ESE in healthy volunteers?
Does a new high-intensity single-stage combined CPET-ESE protocol improve feasibility and provide comparable cardiac function responses compared to standard maximal ESE in healthy volunteers?
Absolute Event Rate: 76.2% vs 42.9%
p-value: p=0.07
A novel single-stage combined CPET-ESE protocol provides better data completeness at lower exertion levels compared to standard maximal ESE, without compromising cardiac reserve measurements.
May improve RV strain feasibility during exercise testing; leaves open validation in patients before clinical adoption.
Aims The value of cardiopulmonary exercise testing (CPET) and exercise stress echocardiography (ESE) in managing cardiac disease is well known, but no standard CPET–ESE protocol is currently recommended. This pilot study aims to compare feasibility and cardiac function responses between a new high-intensity single-stage combined test (CPET–hiESE) and a standard maximal ESE (smESE). Methods and results After screening and maximal CPET, all volunteers (n = 21) underwent three ESE modalities: (i) based on the gas exchange threshold (hiESE–GET, 40% of peak-GET, 6 min), (ii) based on heart rate (HR) (hiESE–HR, 80% of peak HR, 6 min), and (iii) smESE (85% of predicted peak HR for age, 3 min). Speckle tracking echocardiography (STE) and tissue Doppler imaging (TDI) were measured at each step. There was superior image quality and data completeness for the right ventricle strain for both hiESE modalities compared with smESE (71.4 and 76.2 vs. 42.9%, P = 0.07). Left ventricular STE data completeness was similar for all three conditions. Despite systematically higher HR, work rate and levels of exertion in the smESE compared with hiESE, STE and TDI parameters were not systematically different. Concordance correlation coefficients ranged from 0.56 to 0.88, lowest for strain rate parameters and mean difference from −0.34 to 1.53, highest for TDI measurements. Conclusion The novel CPET–hiESE protocol allowed for better data completeness, at lower levels of exertion compared with smESE, without systematically different cardiac reserve measurements in healthy participants. This single-stage protocol can be individualized to clinical populations, which would provide practical advantages to standard testing.
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Dorobantu et al. (2024) studied Healthy participants (n=21). High-intensity single-stage combined cardiopulmonary and echocardiography exercise test (CPET-hiESE) vs. Standard maximal ESE (85% of predicted peak HR for age, 3 min) was evaluated on Data completeness for right ventricle strain (p=0.07). The novel CPET-hiESE protocol yielded better data completeness for right ventricle strain compared with standard maximal ESE (71.4% and 76.2% vs. 42.9%, P=0.07) at lower levels of exertion.
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