Key result
Food intake plus preload augmentation boosts LV cardiac output by ~1.9 L/min over preload alone.
Why the study?
The impact of food intake and preload augmentation on cardiac output and biventricular volumes assessed by CMR and TTE remains to be determined.
Does food intake combined with preload augmentation affect cardiac functional parameters and volumes compared to preload augmentation alone in patients undergoing cardiac imaging?
Cross-Sectional (n=82)
Blinded analysis (offline processing blinded to fluid and food status)
None (sequential allocation)
No
Does food intake combined with preload augmentation affect cardiac functional parameters and volumes compared to preload augmentation alone in patients undergoing cardiac imaging?
Absolute Event Rate: 2.6% vs 0.7%
p-value: p=<0.001
Food intake combined with preload augmentation significantly alters cardiac hemodynamics and ventricular volumes compared to preload augmentation alone, suggesting that patients should fast prior to sequential cardiac functional assessments to avoid misinterpretation of changes.
Greater LV output rise with food plus preload; leaves open whether fasting is needed before serial cardiac assessments.
(1) Background: To investigate how food intake and preload augmentation affect the cardiac output (CO) and volumes of the left ventricle (LV) and right ventricle (RV) assessed using cardiac magnetic resonance (CMR) and trans-thoracic echocardiography (TTE). (2) Methods: Eighty-two subjects with (n = 40) and without (n = 42) cardiac disease were assessed using both CMR and TTE immediately before and after a fast infusion of 2 L isotonic saline. Half of the population had a meal during saline infusion (food/fluid), and the other half were kept fasting (fasting/fluid). We analyzed end-diastolic (EDV) and end-systolic (ESV) volumes and feature tracking (FT) using CMR, LV global longitudinal strain (GLS), and RV longitudinal strain (LS) using TTE. (3) Results: CO assessed using CMR increased significantly in both groups, and the increase was significantly higher in the food/fluid group: LV-CO (ΔLV-CO: +2.6 ± 1.3 vs. +0.7 ± 1.0 p < 0.001), followed by increased heart rate (HR) (ΔHR: +12 ± 8 vs. +1 ± 6 p < 0.001). LV and RV achieved increased stroke volume (SV) through different mechanisms. For the LV, through increased contractility, increased LV-EDV, decreased LV-ESV, increased LV-FT, and GLS were observed. For the RV, increased volumes, increased RV-EDV, increased RV-ESV, and at least for the fasting/fluid group, unchanged RV-FT and RV-LS were reported. (4) Conclusions: Preload augmentation and food intake have a significant impact on hemodynamic and cardiac functional parameters. This advocates for standardized recommendations regarding oral intake of fluid and food before cardiac assessment, for example, TTE, CMR, and right heart catheterization. We also demonstrate different approaches for the LV and RV to increase SV: for the LV by increased contractility, and for the RV by volume expansion.
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Visby et al. (2023) conducted a cross-sectional in Subjects with and without cardiac disease (n=82). Food intake combined with preload augmentation vs. Fasting state combined with preload augmentation (2 L isotonic saline) was evaluated on Mean change in left ventricular cardiac output (LV-CO) assessed by CMR (p=<0.001). Food intake combined with preload augmentation significantly increased left ventricular cardiac output compared to preload augmentation alone (+2.6 ± 1.3 L/min vs. +0.7 ± 1.0 L/min, p<0.001).
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