Easy-to-Use Preload Stress Echocardiography by Using Combined Dynamic Postural Stress Can Identify High-Risk Patients with Heart Failure with Reduced Ejection Fraction

Figures

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  Figure 1. Frank–Starling curves and passive length–tension relationships during dynamic postural stress in healthy controls and in heart failure with reduced ejection fraction (HFrEF) patients with and without cardiovascular events. Frank–Starling curves (A) and passive length–tension relationships (B) for healthy controls (green) and for HFrEF patients with (red) and without (blue) adverse cardiovascular events are shown. Solid dots, triangles, and squares indicate mean values obtained at baseline, during semi‐sitting position, and with passive leg‐lifting, respectively. Each bar and shading area indicate ±2 SDs and 95% confidence intervals. LVEDVI, left ventricular end‐diastolic volume index.

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  Figure 2. Comparisons of changes in stroke volume index during semi‐sitting position and passive leg‐lifting for healthy controls and for heart failure with reduced ejection fraction (HFrEF) patients with and without cardiovascular events. The net difference in stroke volume index (ΔSVi) during combined postural stress was comparable between healthy controls and HFrEF patients without cardiovascular events. However, ΔSVi was significantly smaller in patients with adverse events.

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  Figure 3. Comparisons of the prognostic value of different Cox models for predicting adverse cardiovascular events. This figure compares the prognostic value of different Cox models for predicting adverse cardiovascular events and illustrates the global χ 2 of nested Cox models, incorporating clinical, conventional echocardiographic, and combined postural stress parameters. BNP, brain natriuretic peptide; LVEDVI, left ventricular end‐diastolic volume index; LVEF, left ventricular ejection fraction; NYHA, New York Heart Association; ΔSVi, net difference in stroke volume index.

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  Figure 4. Comparison of event‐free survival using Kaplan–Meier curve analysis stratified by the net difference in stoke volume index (ΔSVi) during combined postural stress. When patients were divided into three equal subgroups based on net difference in forward stroke volume index during combined postural stress (ΔSVi), patients with impaired preload reserve (third tertile, ΔSVi < 3.2 mL/m2) showed significantly worse event‐free survival compared with the other two subgroups.