Fabiani Iacopo, Pugliese Nicola Riccardo, Santini Claudia, Miccoli Mario, D'Agostino Andreina, Rovai Ilaria, Mazzola Matteo, Pedrinelli Roberto, Dini Frank Lloyd
Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
Department of Surgical, Medical, Molecular and Critical Care Pathology, Fresno, USA.
Cardiovasc Ultrasound. 2019 Apr 6;17(1):6. doi: 10.1186/s12947-019-0157-z.
The contractile response of patients with heart failure (HF) may be assessed by exercise stress echocardiography (ESE)-derived indexes. We sought to test whether ESE parameters are useful to identify the risk of adverse left ventricular (LV) remodeling in patients with chronic HF and reduced or mildly reduced LV ejection fraction (EF).
We enrolled 155 stabilized patients (age: 62 ± 11 years, 17% female, coronary artery disease 47%) with chronic HF, LV EF ≤50% and LV end-diastolic volume index > 75 ml/m. All patients underwent a symptom-limited graded bicycle semi-supine ESE, with evaluation of peak stress LV EF, end-systolic pressure-volume relation (ESPVR, i.e. LV elastance) and cardiac power output to LV mass (CPOM). A complete echocardiographic study was performed at baseline and after 6 ± 3 months. Adverse LV remodeling was defined as the association of eccentric LV hypertrophy (LV mass: ≥115 g/m for male and ≥ 95 g/m for women, and relative wall thickness < 0.32) with an increase in LV end-systolic volume index ≥10% at six months.
Adverse LV remodeling was detected in 34 (22%) patients. After adjustment for clinical, biochemical and echocardiographic data, peak ESPVR resulted in the most powerful independent predictor of adverse LV remodeling (OR: 12.5 [95% CI 4.5-33]; p < 0.0001) followed by ischemic aetiology (OR: 2.64 [95% 1.04-6.73]; p = 0.04).
In patients with HF and reduced or mildly reduced EF, a compromised ESE-derived peak ESPVR, that reflects impaired LV contractility, resulted to be the most powerful predictor of adverse LV remodeling.
心力衰竭（HF）患者的收缩反应可通过运动负荷超声心动图（ESE）得出的指标进行评估。我们旨在测试ESE参数是否有助于识别慢性HF且左心室（LV）射血分数（EF）降低或轻度降低患者发生不良LV重构的风险。
我们纳入了155例病情稳定的慢性HF患者（年龄：62±11岁，女性占17%，冠心病占47%），LV EF≤50%且LV舒张末期容积指数>75 ml/m²。所有患者均接受了症状限制的分级半卧位自行车ESE检查，评估了峰值负荷时的LV EF、收缩末期压力-容积关系（ESPVR，即LV弹性）以及心脏功率输出与LV质量之比（CPOM）。在基线时和6±3个月后进行了完整的超声心动图检查。不良LV重构定义为在6个月时出现偏心性LV肥厚（男性LV质量：≥115 g/m²，女性≥95 g/m²，相对室壁厚度<0.32）且LV收缩末期容积指数增加≥10%。
34例（22%）患者检测到不良LV重构。在对临床、生化和超声心动图数据进行调整后，峰值ESPVR是不良LV重构最有力的独立预测指标（OR：12.5 [95% CI 4.5 - 33]；p < 0.0001），其次是缺血性病因（OR：2.64 [95% 1.04 - 6.73]；p = 0.04）。
在HF且EF降低或轻度降低的患者中，ESE得出的受损峰值ESPVR反映了LV收缩功能受损，是不良LV重构最有力的预测指标。
