Echocardiography and invasive hemodynamics during stress testing for diagnosis of heart failure with preserved ejection fraction: an experimental study

• Type: Article in International Scientific Journal
• Date: 2015

Authors

Leite, S (Author) FMUP; Oliveira Pinto, J (Author) FMUP; Tavares Silva, M (Author) FMUP; Abdellatif, M (Author) Other; Fontoura, D (Author) Other; Falcao Pires, I (Author) FMUP; Leite-Moreira AF (Author) FMUP; Andre P Lourenco (Author) FMUP

Journal

Title: American Journal of Physiology - Heart and Circulatory Physiology

Vol. 308

ISSN: 0363-6135

Publisher: American Physiological Society

Indexing

ISI Web of Knowledge - 39 Citations

Scopus - 42 Citations

Other information

Authenticus ID: P-00G-C02

DOI: 10.1152/ajpheart.00076.2015

Abstract (EN): Inclusion of exercise testing in diagnostic guidelines for heart failure with preserved ejection fraction (HFpEF) has been advocated, but the target population, technical challenges, and underlying pathophysiological complexity raise difficulties to implementation. Hemodynamic stress tests may be feasible alternatives. Our aim was to test Trendelenburg positioning, phenylephrine, and dobutamine in the ZSF1 obese rat model to find echocardiographic surrogates for end-diastolic pressure (EDP) elevation and HFpEF. Seventeen-week-old Wistar-Kyoto, ZSF1 lean, and obese rats (n = 7 each) randomly and sequentially underwent (crossover) Trendelenburg (30 degrees), 5 mu g.Kg(-1).min(-1) dobutamine, and 7.5 mu g.Kg(-1).min(-1) phenylephrine with simultaneous left ventricular (LV) pressure-volume loop and echocardiography evaluation under halogenate anesthesia. Effort testing with maximum O-2 consumption ((V) over dotO(2 max)) determination was performed 1 wk later. Obese ZSF1 showed lower effort tolerance and (V) over dotO(2 max) along with higher resting EDP. Both Trendelenburg and phenylephrine increased EDP, whereas dobutamine decreased it. Significant correlations were found between EDP and 1) peak early filling Doppler velocity of transmitral flow (E) to corresponding myocardial tissue Doppler velocity (E') ratio, 2) E to E-wave deceleration time (E/DT) ratio, and 3) left atrial area (LAA). Diagnostic efficiency of E/DT*LAA by receiver-operating characteristic curve analysis for elevation of EDP above a cut-off of 13 mmHg during hemodynamic stress was high (area under curve, AUC = 0.95) but not higher than that of E/E' (AUC = 0.77, P = 0.15). Results in ZSF1 obese rats suggest that noninvasive echocardiography after hemodynamic stress induced by phenylephrine or Trendelenburg can enhance diagnosis of stable HFpEF and constitute an alternative to effort testing.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 8