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Minerva Cardioangiologica 2020 Jul 10

DOI: 10.23736/S0026-4725.20.05304-9

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Feasibility and value of two-dimensional volumetric stress echocardiography

Tonino BOMBARDINI 1, Angela ZAGATINA 2, Quirino CIAMPI 3, Lauro CORTIGIANI 4, Antonello D'ANDREA 5, Clarissa BORGUEZAN DAROS 6, Nadezhda ZHURAVSKAYA 2, Jaroslaw D. KASPRZAK 7, Karina WIERZBOWSKA-DRABIK 7, José L. DE CASTRO e SILVA PRETTO 8, Ana DJORDJEVIC-DIKIC 9, Branko BELESLIN 9, Marija PETROVIC 9, Nikola BOSKOVIC 9, Milorad TESIC 9, Ines P. MONTE 10, Iana SIMOVA 11, Martina VLADOVA 11, Alla BOSHCHENKO 12, Tamara RYABOVA 12, Rodolfo CITRO 13, Miguel AMOR 14, Paul E. VARGAS MIELES 14, Rosina ARBUCCI 15, Claudio DODI 16, Fausto RIGO 17, Suzana GLIGOROVA 18, Milica DEKLEVA 19, Sergio SEVERINO 20, Marco A. TORRES 21, Alessandro SALUSTRI 22, Hugo RODRÌGUEZ-ZANELLA 23, Fabio M. COSTANTINO 24, Albert VARGA 25, Gergely AGOSTON 25, Eduardo BOSSONE 26, Francesco FERRARA 26, Nicola GAIBAZZI 27, Granit RABIA 27, Jelena CELUTKIENE 28, Maciej HABERKA 29, Fabio MORI 30, Maria Grazia D'ALFONSO 30, Barbara REISENHOFER 31, Ana C. CAMAROZANO 32, Michael SALAMÉ 14, Ewa SZYMCZYK 7, Paulina WEJNER-MIK 7, Katarzyna WDOWIAK-OKROJEK 7, Tamara KOVACEVIC PRERADOVIC 1, Fabio LATTANZI 33, Doralisa MORRONE 33, Maria Chiara SCALI 34, Miodrag OSTOJIC 35, Aleksandra NIKOLIC 35, Federica RE 36, Andrea BARBIERI 37, Giovanni DI SALVO 38, Paolo COLONNA 39, Michele DE NES 40, Marco PATERNI 40, Pablo M. MERLO 15, Jorge LOWENSTEIN 15, Clara CARPEGGIANI 40, Dario GREGORI 41, Eugenio PICANO 40 , on behalf of the Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging

1 Clinical Center of The Republic of Srpska, Faculty of Medicine, University of Banja-Luka, Banja-Luka, Bosnia-Herzegovina; 2 Cardiology Department, Saint Petersburg University Clinic, Saint Petersburg University, Saint Petersburg, Russian Federation; 3 Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy; 4 Cardiology Department, San Luca Hospital, Lucca, Italy; 5 Echocardiography Lab and Rehabilitation Unit, Cardiology Department, Monaldi Hospital, Second University of Naples, Naples, Italy; 6 Cardiology Division, Hospital Sao José, Criciuma, Brasil; 7 Chair of Cardiology, Bieganski Hospital, Medical University, Lodz, Poland; 8 Hospital Sao Vicente de Paulo e Hospital de Cidade, Passo Fundo, Brasil; 9 Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia; 10 Cardio-Thorax-Vascular Department, Echocardiography lab, A.O.U. Policlinic Rodolico, Catania University, Catania, Italy; 11 Head of Cardiology Department, Acibadem City Clinic Cardiovascular Center, University Hospital, Sofia, Bulgaria; 12 Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation; 13 Cardiology Department and Echocardiography Lab, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy; 14 Ramos Mejia Hospital, CABA, Buenos Aires, Argentina; 15 Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina; 16 Casa di Cura Figlie di San Camillo, Cremona, Italy; 17 Cardiology Department, Ospedale dell'Angelo, Mestre, Venice, Italy; 18 Cardiology Division Ospedale Casilino, Roma, Italy; 19 Clinical Center Zvezdara, Belgrade, Serbia; 20 Coronary Care Unit, Cardiology Department, Monaldi Hospital, Second University of Naples, Naples, Italy; 21 Universidade Federal do Rio Grande do Sul, Porto Alegre, Brasil; 22 Non-invasive Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar; 23 Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico; 24 Cardiology Department, San Carlo Hospital, Potenza, Italy; 25 Institute of Family Medicine, University of Szeged, Szeged, Hungary; 26 Azienda Ospedaliera Rilevanza Nazionale A. Cardarelli Hospital, Naples, Italy; 27 Cardiology Department, Parma University Hospital, Parma, Italy; 28 Centre of Cardiac and Vascular Diseases, Institute of Clinical medicine, Faculty of Medicine, Vilnius University Hospital, Vilnius, Lithuania; 29 Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland; 30 SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy; 31 Cardiology Division, Pontedera-Volterra Hospital, ASL Toscana3 Nord-Ovest, Volterra, Pisa, Italy; 32 Medicine Department, Hospital de Clinicas UFPR, Federal University of Paranà, Curitiba, Brasil; 33 Molecular Pathology and Critical Area Medicine-Cardiovascular Disease Section, Department of Surgical, Medical, University of Pisa, Pisa, Italy; 34 Cardiology Division, Ospedale Nottola-Montepulciano, Siena-ASL Toscana Centro, Montepulciano, Florence, Italy; 35 School of Medicine, Institute for Cardiovascular Disease Dedinje, Belgrade, Serbia; 36 Cardiology Division, Ospedale San Camillo, Rome, Italy; 37 Cardiology Division, Policlinico University Hospital of Modena, Modena, Italy; 38 Cardiology Division, Pediatric Cardiology Department, Brompton Hospital, Imperial College of London, London, UK; 39 Cardiology Hospital, Policlinico University Hospital of Bari, Bari, Italy; 40 Biomedicine Department, CNR, Institute of Clinical Physiology, Pisa, Italy; 41 Biostatistics, Epidemiology and Public Health Unit, Padova University, Padua, Italy


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BACKGROUND: Stroke volume response during stress is a major determinant of functional status in heart failure and can be measured by two-dimensional (2-D) volumetric stress echocardiography (SE). The present study hypothesis is that SE may identify mechanisms underlying the change in stroke volume by measuring preload reserve through end-diastolic volume (EDV) and left ventricular contractile reserve (LVCR) with systolic blood pressure and end-systolic volume (ESV).
METHODS: We enrolled 4,735 patients (age 63.6 ± 11.3 yrs, 2800 male) referred to SE for known or suspected coronary artery disease (CAD) and/or heart failure (HF) in 21 SE laboratories in 8 countries. In addition to regional wall motion abnormalities (RWMA), force was measured at rest and peak stress as the ratio of systolic blood pressure by cuff sphygmomanometer/ESV by 2D with Simpson's or linear method. Abnormal values of LVCR (peak/rest) based on force were ≤1.10 for dipyridamole (n=1,992 patients) and adenosine (n=18); ≤2.0 for exercise (n=2,087) or dobutamine (n=638).
RESULTS: Force-based LVCR was obtained in all 4,735 pts. Lack of stroke volume increase during stress was due to either abnormal LVCR and/or blunted preload reserve, and 57 % of patients with abnormal LVCR nevertheless showed increase in stroke volume.
CONCLUSIONS: Volumetric SE is highly feasible with all stresses, and more frequently impaired in presence of ischemic RWMA, absence of viability and reduced coronary flow velocity reserve. It identifies an altered stroke volume response due to reduced preload and/or contractile reserve.


KEY WORDS: Contractility; Echocardiography; Preload; End-diastolic volume; End-systolic volume

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