Hemodynamic Heterogeneity of Reduced Cardiac Reserve Unmasked by Volumetric Exercise Echocardiography
Key result
Reduced preload reserve (OR 5.610; 95% CI 4.025-7.821), chronotropic incompetence, and abnormal left ventricular contractile reserve were independently associated with reduced cardiac index reserve.
Why the study?
The study was conducted to assess the dependence of cardiac reserve upon left ventricular contractile reserve, end-diastolic volume, and heart rate during exercise stress echocardiography.
Population
1344 patients with known or suspected coronary artery disease and negative ESE by wall motion criteria
Design
Prospective observational study
Authors
Discussion
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Implication
Volumetric ESE phenotyping may clarify mechanisms of reduced cardiac reserve; leaves open whether targeting specific deficits improves outcomes.
Study Design
Type
Observational (n=1,344)
Structured PICO
P
Population
1,344 patients (mean age 59.8 years) referred for known or suspected coronary artery disease who had negative exercise stress echocardiography by wall motion criteria.
E
Exposure
Semi-supine bicycle or treadmill exercise stress echocardiography (ESE) with volumetric assessment (EDV, ESV, LV contractile reserve, and heart rate reserve).
O
Outcome
Lowest tertile of cardiac index reserve at peak stress.surrogate
Main Result
Odds Ratio: 5.61 (95% CI 4.025–7.821)
Volumetric exercise echocardiography can identify distinct hemodynamic phenotypes (impaired chronotropic, preload, or contractile reserve) underlying reduced cardiac reserve in patients with suspected CAD and normal wall motion.
Cite This Study
Bombardini et al. (2021) conducted an observational in Known or suspected coronary artery disease (n=1,344). Reduced preload reserve, chronotropic incompetence, and abnormal LV contractile reserve was evaluated on Lowest tertile of cardiac index reserve at peak stress (OR 5.610, 95% CI 4.025-7.821). Reduced preload reserve (OR 5.610; 95% CI 4.025-7.821), chronotropic incompetence, and abnormal left ventricular contractile reserve were independently associated with reduced cardiac index reserve.