Stress echo 2020 : the international stress echo study in ischemic and non-ischemic heart disease

Background: Stress echocardiography (SE) has an established role in evidence-based guidelines, but recently its breadth and variety of applications have extended well beyond coronary artery disease (CAD). We lack a prospective research study of SE applications, in and beyond CAD, also considering a variety of signs in addition to regional wall motion abnormalities. Methods: In a prospective, multicenter, international, observational study design, > 100 certified high-volume SE labs (initially from Italy, Brazil, Hungary, and Serbia) will be networked with an organized system of clinical, laboratory and imaging data collection at the time of physical or pharmacological SE, with structured follow-up information. The study is endorsed by the Italian Society of Cardiovascular Echography and organized in 10 subprojects focusing on: contractile reserve for prediction of cardiac resynchronization or medical therapy response; stress B-lines in heart failure; hypertrophic cardiomyopathy; heart failure with preserved ejection fraction; mitral regurgitation after either transcatheter or surgical aortic valve replacement; outdoor SE in extreme physiology; right ventricular contractile reserve in repaired Tetralogy of Fallot; suspected or initial pulmonary arterial hypertension; coronary flow velocity, left ventricular elastance reserve and B-lines in known or suspected CAD; identification of subclinical familial disease in genotype-positive, phenotype- negative healthy relatives of inherited disease (such as hypertrophic cardiomyopathy). Results: We expect to recruit about 10,000 patients over a 5-year period (2016-2020), with sample sizes ranging from 5,000 for coronary flow velocity/ left ventricular elastance/ B-lines in CAD to around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of Fallot. This data-base will allow to investigate technical questions such as feasibility and reproducibility of various SE parameters and to assess their prognostic value in different clinical scenarios. Conclusions: The study will create the cultural, informatic and scientific infrastructure connecting high-volume, accredited SE labs, sharing common criteria of indication, execution, reporting and image storage of SE to obtain original safety, feasibility, and outcome data in evidence-poor diagnostic fields, also outside the established core application of SE in CAD based on regional wall motion abnormalities. The study will standardize procedures, validate emerging signs, and integrate the new information with established knowledge, helping to build a next-generation SE lab without inner walls

Heart failure 2019: insights from the National Society of Cardiology Journals

INTRODUCTION Most studies on heart failure (HF) management published in 2019 by high-ranking impact factor international journals focus on drug therapy. This included administration of sacubitril-valsartan with initiation during the index admission and the benefits of SGLT2 inhibitors in reducing cardiovascular mortality and HF. Most of these studies, targeting a broad readership, fail to characterize important local issues. Improvement in HF management needs to take into account specificities from different European Society of Cardiology (ESC) member countries. This approach may be achieved and disseminated to cardiologists by the National Society of Cardiology Journals (NSCJ). During the ESC Congress 2019, the ESC Editors’ Network started an initiative intended to boost dissemination of cardiology research published in the NSCJ by summarizing in a review paper the evidence gathered in selected areas. The ESC Editors Network members decided the first topic of such a review to be publications in the field of HF. Epidemiology Inequalities in the prevalence of risk factors, cardiovascular disease burden, cardiovascular mortality, and implementation of some therapeutic methods (coronary interventions, device implantations, and cardiac surgery) among the ESC member countries have recently been shown in the ATLAS study. These shortcomings depend on socio- economic factors and affect more predominantly middle-income than high-income countries. In..

Left atrial dysfunction detected by speckle tracking in patients with systemic sclerosis

BACKGROUND: Cardiac involvement is a relevant clinical finding in systemic sclerosis (SSc) and is associated with poor prognosis. Left atrial (LA) remodeling and/or dysfunction can be an early sign of diastolic dysfunction. Two-dimensional speckle tracking echocardiography (STE) is a novel and promising tool for detecting very early changes in LA myocardial performance. AIM: To assess whether STE strain parameters may detect early alterations in LA function in SSc patients. METHODS: Forty-two SSc patients (Group 1, age 50\u2009\ub1\u200914 years, 95% females) without clinical evidence for cardiac involvement and 42 age- and gender-matched control subjects (Group 2, age 49\u2009\ub1\u200913 years, 95% females) were evaluated with comprehensive 2D and Doppler echocardiography, including tissue Doppler imaging analysis. Positive peak left atrial longitudinal strain (\u3f5 pos peak), second positive left atrial longitudinal strain (sec \u3f5 pos peak), and negative left atrial longitudinal strain (\u3f5 neg peak) were measured using a 12-segment model for the LA, by commercially available semi-automated 2D speckle-tracking software (EchoPac PC version 108.1.4, GE Healthcare, Horten, Norway). RESULTS: All SSc patients had a normal left ventricular ejection fraction (63.1\u2009\ub1\u20094%). SSc patients did not differ from controls in E/A (Group 1\u2009=\u20091.1\u2009\ub1\u20090.4 vs Group 2\u2009=\u20091.3\u2009\ub1\u20090.4, p\u2009=\u2009.14) or pulmonary arterial systolic pressure (Group 1\u2009=\u200924.1\u2009\ub1\u20098 mmHg vs Group 2\u2009=\u200921\u2009\ub1\u20097 mmHg, p\u2009=\u2009.17). SSc patients did not show significantly different indexed LA volumes (Group 1\u2009=\u200924.9\u2009\ub1\u20095.3 ml/m2 vs Group 2\u2009=\u200924.7\u2009\ub1\u20094.4 ml/m2, p\u2009=\u2009.8), whereas E/e' ratio was significantly higher in SSc (Group 1\u2009=\u20097.6\u2009\ub1\u20092.4 vs Group 2\u2009=\u20096.5\u2009\ub1\u20091.7, p<0.05), although still within normal values. LA strain values were significantly different between the two groups (\u3f5 pos peak Group 1\u2009=\u200931.3\u2009\ub1\u20094.2% vs Group 2\u2009=\u200935.0\u2009\ub1\u20097.6%, p\u2009<\u2009.01, sec \u3f5 pos peak Group 1\u2009=\u200918.4\u2009\ub1\u20094 vs Group 2\u2009=\u200921.4\u2009\ub1\u20097.6, p\u2009<\u20090.05). CONCLUSION: 2D speckle-tracking echocardiography is a sensitive tool to assess impairment of LA mechanics, which is detectable in absence of changes in LA size and volume, and may represent an early sign of cardiac involvement in patients with SSc

Clinical and echocardiographic correlations of exercise-induced pulmonary hypertension in systemic sclerosis: A multicenter study

BACKGROUND: Patients with systemic sclerosis (SSc) are at risk for developing pulmonary hypertension, which is associated with a poor prognosis. Exercise Doppler echocardiography enables the identification of exercise-induced increase in pulmonary artery systolic pressure (PASP) and may provide a thorough noninvasive hemodynamic evaluation. AIM: The aim of this study was to evaluate the clinical and echocardiographic determinants of exercise-induced increase in PASP in a large population of patients with SSc. METHODS: We selected 164 patients with SSc (age 58 \ub1 13 years, 91% female) with normal resting PASP (<40 mm Hg) who underwent a comprehensive 2-dimensional and Doppler echocardiography and graded bicycle semisupine exercise Doppler echocardiography. Pulmonary artery systolic pressure, cardiac output, and pulmonary vascular resistance (PVR) were estimated noninvasively. Cutoff values of PASP 6550 mm Hg and PVR 653.0 Wood Units at peak exercise were considered a significant exercise-induced increase in PASP and PVR, respectively. RESULTS: Sixty-nine (42%) patients showed a significant exercise-induced increase in PASP. Among them, peak PVR 653 Wood Units was present only in 11% of patients, about 5% of the total population. Univariate analysis showed that age, presence of interstitial lung disease, and both right and left diastolic dysfunction are predictors of peak PASP 6550 mm Hg, but none of these parameters predict elevated peak PVR. CONCLUSIONS: Exercise-induced increase in PASP occurs in almost one-half of patients with SSc with normal resting PASP. Peak exercise PASP is affected by age, interstitial lung disease, and right and left ventricular diastolic dysfunction and, only in 5% of the patients, is associated with an increase in PVR during exercise, suggesting heterogeneity of the mechanisms underlying exercise-induced pulmonary hypertension in SSc

The Right Heart International Network (RIGHT-NET) : Rationale, Objectives, Methodology, and Clinical Implications

The Right Heart International Network is a multicenter international study aiming to prospectively collect exercise Doppler echocardiography tests of the right heart pulmonary circulation unit (RHPCU) in large cohorts of healthy subjects, elite athletes, and individuals at risk of or with overt pulmonary hypertension. It is going to provide standardization of exercise stress echocardiography of RHPCU and explore the full physiopathologic response

Feasibility and functional correlates of left atrial volume changes during stress echocardiography in chronic coronary syndromes

: An enlarged left atrial volume index (LAVI) at rest mirrors increased LA pressure and/or impairment of LA function. A cardiovascular stress may acutely modify left atrial volume (LAV) within minutes. Aim of this study was to assess the feasibility and functional correlates of LAV-stress echocardiography (SE) Out of 514 subjects referred to 10 quality-controlled labs, LAV-SE was completed in 490 (359 male, age 67 ± 12&nbsp;years) with suspected or known chronic coronary syndromes (n = 462) or asymptomatic controls (n = 28). The utilized stress was exercise in 177, vasodilator in 167, dobutamine in 146. LAV was measured with the biplane disk summation method. SE was performed with the ABCDE protocol. The intra-observer and inter-observer LAV variability were 5% and 8%, respectively. ∆-LAVI changes (stress-rest) were negatively correlated with resting LAVI (r = -&nbsp;0.271, p &lt; 0.001) and heart rate reserve (r = -.239, p &lt; 0.001). LAV-dilators were defined as those with stress-rest increase ≥ 6.8&nbsp;ml/m2, a cutoff derived from a calculated reference change value above the biological, analytical and observer variability of LAVI. LAV dilation occurred in 56 patients (11%), more frequently with exercise (16%) and dipyridamole (13%) compared to dobutamine (4%, p &lt; 0.01). At multivariable logistic regression analysis, B-lines ≥ 2 (OR: 2.586, 95% CI = 1.1293-5.169, p = 0.007) and abnormal contractile reserve (OR: 2.207, 95% CI = 1.111-4.386, p = 0.024) were associated with LAV dilation. In conclusion, LAV-SE is feasible with high success rate and low variability in patients with chronic coronary syndromes. LAV dilation is more likely with reduced left ventricular contractile reserve and pulmonary congestion

Feasibility and value of two-dimensional volumetric stress echocardiography

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)