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Pediatric Cardiology Feb 2023The most significant sequelae of Kawasaki disease (KD) are coronary artery aneurysms, which can lead to risk of future myocardial ischemia. Exercise stress... (Review)
Review
The most significant sequelae of Kawasaki disease (KD) are coronary artery aneurysms, which can lead to risk of future myocardial ischemia. Exercise stress echocardiography allows for non-invasive assessment of myocardial dysfunction. We reviewed our single center experience with exercise stress echocardiography in patients with previous history of KD with coronary aneurysms. We reviewed the records of 53 KD patients who underwent exercise stress echocardiography from 2000 to 2020. Abnormal stress echocardiograms were defined as those showing no increase in biventricular systolic function post-exercise or regional wall motion abnormalities. Computed tomography angiography and cardiac magnetic resonance imaging were reviewed for patients with abnormal stress echocardiograms. Clinical data were reviewed and correlated with stress echocardiogram results. Of the 53 patients, three (5.7%) had an abnormal exercise stress echocardiogram. All three patients were classified as AHA Risk Level 4 or 5 by coronary Z-score (internal dimension normalized for body surface area) and were confirmed to have coronary aneurysms, stenosis, or myocardial tissue perfusion defects on advanced cardiac imaging that could account for the results seen on stress echocardiogram. Exercise stress echocardiography detected signs of myocardial ischemia in a subset of high-risk patients with Kawasaki disease and coronary aneurysms and may be considered as a useful screening tool for this complex patient cohort.
Topics: Humans; Coronary Aneurysm; Echocardiography, Stress; Mucocutaneous Lymph Node Syndrome; Coronary Artery Disease; Myocardial Ischemia; Exercise Test; Coronary Angiography
PubMed: 36383234
DOI: 10.1007/s00246-022-03037-1 -
JACC. Cardiovascular Imaging Apr 2015
Topics: Coronary Artery Disease; Echocardiography, Stress; Female; Humans; Male; Vascular Calcification
PubMed: 25882570
DOI: 10.1016/j.jcmg.2014.12.021 -
ESC Heart Failure Dec 2022Abnormal left ventricular diastolic response to preload stress can be an early marker of heart failure (HF). The aim of this study was to assess clinical course in...
AIMS
Abnormal left ventricular diastolic response to preload stress can be an early marker of heart failure (HF). The aim of this study was to assess clinical course in patients with HF with preserved ejection fraction (HFpEF) who underwent preload stress echocardiography. In the subgroup analysis, we assessed the prognosis of patients with unstable signs during preload stress classified by treatment strategies.
METHODS AND RESULTS
We prospectively conducted preload stress echocardiographic studies between January 2006 and December 2013 in 211 patients with HFpEF. Fifty-eight patients had abnormal diastolic reserve during preload stress (unstable impaired relaxation: unstable IR). Of 58 patients with unstable IR, 19 patients were assigned to additional therapy by increased or additional therapy and 39 patients were assigned to standard therapy. Composite outcomes were prespecified as the primary endpoint of death and hospitalization for deteriorating HF. During a median period of 6.9 years, 19 patients (33%) reached the composite outcome. Unstable group with standard therapy had significantly shorter event-free survival than stable group. Patients with uptitration of therapy had longer event-free survival than those with standard therapy group after adjustment of laboratory data (hazard ratio, 0.20, 95% confidence interval, 0.05-0.90; P = 0.036); the 10 year event-free survival in patients with and without uptitration of therapy was 93% and 51%, respectively (P = 0.023).
CONCLUSIONS
Patients with unstable sign had significantly shorter event-free survival than patients with stable sign. After additional therapy, the prognosis of patients with unstable signs improved. This technique may impact decision-making for improving their prognosis.
Topics: Humans; Heart Failure; Echocardiography, Stress; Stroke Volume; Prognosis; Disease Progression
PubMed: 36017722
DOI: 10.1002/ehf2.14127 -
Journal of the American College of... May 2013
Topics: Cardiomyopathy, Dilated; Echocardiography, Stress; Female; Humans; Male; Mitochondria, Heart; Myocardial Contraction; Technetium Tc 99m Sestamibi
PubMed: 23501384
DOI: 10.1016/j.jacc.2013.02.026 -
Scientific Reports Apr 2022Dobutamine stress echocardiography is an alternative method to exercise stress echocardiography for the evaluation of ischemia. Recently, the novel speckle tracking...
Dobutamine stress echocardiography is an alternative method to exercise stress echocardiography for the evaluation of ischemia. Recently, the novel speckle tracking imaging derived parameter, myocardial work index, was suggested for the evaluation of cardiac performance and was evaluated during exercise stress echocardiography. In this study, we analyzed the effect of dobutamine on myocardial work index variables during normal dobutamine stress echocardiography. Echocardiography examinations of patients with normal dobutamine stress echocardiography were collected and underwent off-line speckle tracking imaging analysis. Myocardial work index parameters were calculated at each dose of dobutamine and compared. 286 patients underwent dobutamine stress echocardiography during the study period. 102 patients were excluded due to pre-existed coronary artery disease or ischemia at dobutamine stress echocardiography. 65 patients were excluded due to suboptimal image quality unsuitable for speckle tracking imaging analysis. The remaining 119 patients with normal results were included. The global work index decreased from 2393.3 to 1864.7 mmHg%, p < 0.0004. Global constructive work decreased from 2681.7 to 2152.6 mmHg%, p = 0.001. Global wasted work increased from 78.8 to 128.3 mmHg%, p < 0.003. Global work efficacy decreased from 96.1 to 91.9%, p < 0.00001. Global strain increased from-19.6 to - 23.7%, p < 0.00001. Dobutamine stress echocardiography results in a decrease of all specific myocardial work index parameters even in normal subjects. Only global myocardial strain improved.
Topics: Coronary Artery Disease; Dobutamine; Echocardiography; Echocardiography, Stress; Humans; Myocardium
PubMed: 35473955
DOI: 10.1038/s41598-022-10903-8 -
JACC. Cardiovascular Imaging Feb 2018
Topics: Carotid Arteries; Coronary Artery Disease; Echocardiography, Stress; Humans; Prognosis
PubMed: 28412415
DOI: 10.1016/j.jcmg.2017.01.023 -
Heart (British Cardiac Society) Jan 2003
Review
Topics: Cardiotonic Agents; Coronary Artery Disease; Coronary Stenosis; Dipyridamole; Dopamine; Echocardiography, Stress; False Negative Reactions; False Positive Reactions; Humans; Myocardial Ischemia; Myocardial Stunning; Predictive Value of Tests; Prognosis; Sensitivity and Specificity; Vasodilator Agents
PubMed: 12482809
DOI: 10.1136/heart.89.1.113 -
Hellenic Journal of Cardiology : HJC =... 2022We aimed to assess feasibility and functional correlates of left atrial volume index (LAVI) changes during exercise stress echocardiography (ESE).
OBJECTIVE
We aimed to assess feasibility and functional correlates of left atrial volume index (LAVI) changes during exercise stress echocardiography (ESE).
METHODS
ESE on a bike or treadmill was performed in 363 patients with heart failure with preserved ejection fraction (HFpEF, n = 173), reduced ejection fraction (HFrEF, n = 59), or hypertrophic cardiomyopathy (HCM, n = 131). The LAVI stress-rest increase ≥6.8 ml/m was defined as dilation.
RESULTS
LAVI measurements were feasible in 100%. LAVI did not change in HFrEF being at rest 32 (25-45) vs at stress 36 (24-54) ml/m, P = NS and in HCM at rest 35 (26-48) vs at stress 38 (28-48) ml/m, P = NS, whereas it decreased in HFpEF from 30 (24-40) to 29 (21-37) ml/m at stress, P = 0.007. LA dilation occurred in 107 (30%) patients (27% with treadmill vs 33% with bike ESE, P = NS): 26 with HFpEF (15%), 26 with HFrEF (44%), and 55 with HCM (42%) with P < 0.001 for HFrEF and HCM vs HFpEF. A multivariate analysis revealed as the predictors for LAVI dilation E/e' > 14 at rest with odds ratio (OR) 4.4, LVEF <50% with OR 2.9, and LAVI at rest <35 ml/m with OR 2.7.
CONCLUSION
The LAVI assessment during ESE was highly feasible and dilation equally frequent with a treadmill or bike. LA dilation was three-fold more frequent in HCM and HFrEF and could be predicted by increased resting E/e' and impaired EF as well as smaller baseline LAVI.
Topics: Cardiomyopathy, Hypertrophic; Echocardiography, Stress; Heart Atria; Heart Failure; Humans; Stroke Volume
PubMed: 35123008
DOI: 10.1016/j.hjc.2022.01.003 -
Journal of the American Society of... May 2018The cardiopulmonary vascular system represents a key determinant of prognosis in several cardiorespiratory diseases. Although right heart catheterization is considered... (Review)
Review
The cardiopulmonary vascular system represents a key determinant of prognosis in several cardiorespiratory diseases. Although right heart catheterization is considered the gold standard for assessing pulmonary hemodynamics, a comprehensive noninvasive evaluation including left and right ventricular reserve and function and cardiopulmonary interactions remains highly attractive. Stress echocardiography is crucial in the evaluation of many cardiac conditions, typically coronary artery disease but also heart failure and valvular heart disease. In stress echocardiographic applications beyond coronary artery disease, the assessment of the cardiopulmonary vascular system is a cornerstone. The possibility of coupling the left and right ventricles with the pulmonary circuit during stress can provide significant insight into cardiopulmonary physiology in healthy and diseased subjects, can support the diagnosis of the etiology of pulmonary hypertension and other conditions, and can offer valuable prognostic information. In this state-of-the-art document, the topic of stress echocardiography applied to the cardiopulmonary vascular system is thoroughly addressed, from pathophysiology to different stress modalities and echocardiographic parameters, from clinical applications to limitations and future directions.
Topics: Echocardiography, Stress; Humans; Hypertension, Pulmonary; Pulmonary Artery; Pulmonary Circulation; Reproducibility of Results; Ventricular Function, Right
PubMed: 29573927
DOI: 10.1016/j.echo.2018.01.002 -
Pediatric Cardiology Mar 2015Although exercise stress echocardiography (ESE) is a well-validated technique in adult population, its use in children is quite limited. We aimed to assess the...
Although exercise stress echocardiography (ESE) is a well-validated technique in adult population, its use in children is quite limited. We aimed to assess the feasibility, the safety and the reproducibility of ESE, using on-line scanning in semi-supine cyclo-ergometer protocol in a large pediatric population. Between July 2008 and January 2013, 42 patients (mean age 14 ± 3) were evaluated with a bicycle ESE performing 50 studies. ESE was successfully performed and well tolerated by all patients. None of the patients presented with adverse effects of stress-induced ischemia. HR was 82 ± 13 at rest, and 153 ± 19.1 during peak exercise. Among 544 views analyzed for grading of image quality, the visualization was optimal in 473 (87 %), suboptimal in 39, and inadequate in 32 (6 %). 37 tests were performed in patients with congenital or acquired coronary abnormality. Regional wall motion abnormalities (RWMA) were revealed in nine cases (24 %). The agreement between the two different observers showed a K index of 0.7276 (95 % CI 0.6497-0.8055) for the image quality and a K index of 0.5125 (95 % CI 0.4782-0.5468) for the RWMA analysis. Among ten patients with hypertrophic cardiomyopathy, we were able to demonstrate the new comparison of significant left ventricular outflow tract gradient (≥30 mmHg) during exercise in three patients (30 %). Bicycle stress echocardiography performed by on-line scanning during exercise is a feasible, safe, and reproducible modality in children. Further data to assess its diagnostic accuracy are, however, needed. Stress echocardiography provides a dynamic assessment of the myocardial structure and function under conditions of physiologic or pharmacologic stress.
Topics: Adolescent; Cardiomyopathy, Hypertrophic; Child; Coronary Vessels; Echocardiography, Stress; Exercise Test; Female; Heart; Humans; Male; Risk Assessment; Supine Position; Ventricular Function, Left
PubMed: 25410823
DOI: 10.1007/s00246-014-1058-4