Highlights
- •Low-load exercise stress echocardiography is useful for heart failure patients.
- •Assessing right ventricular function during low-load exercise is important.
- •Right ventricular contractile reserve predicts heart failure readmission.
Abstract
Background
Exercise intolerance in patients with heart failure (HF) increases HF-associated readmission,
and right ventricular (RV) contractile reserve assessed by low-load exercise stress
echocardiography (ESE) is associated with exercise intolerance. This study investigated
the impact of RV contractile reserve evaluated by low-load ESE on HF readmission.
Methods
We prospectively examined 81 consecutive patients hospitalized for HF who underwent
low-load ESE under a stabilized HF condition between May 2018 and September 2020.
We performed a 25-W low-load ESE and defined RV contractile reserve as the increment
in RV systolic velocity (RV s′). The primary outcome was hospital readmission. Incremental
values of the change in RV s′ over a readmission risk (RR) score were analyzed using
the receiver operating characteristic (ROC) area under the curve; internal validation
using bootstrapping was performed. The association between RV contractile reserve
and HF readmission was illustrated with the Kaplan-Meier curve.
Results
Eighteen (22 %) patients were readmitted due to worsening HF during the observation
period (median 15.6 months). The cut-off value of 0.68 cm/s for the change in RV s′
to predict HF readmission with the ROC curve analysis indicated good sensitivity (100 %)
and specificity (76.2 %). The discriminatory ability for HF readmission was significantly
improved by adding the change in RV s′ to the RR score (p = 0.006), and the c-statistic using the bootstrap method was 0.92. The cumulative
survival rate free of HF readmission was significantly lower in patients with reduced-RV
contractile reserve (log-rank test, p < 0.001).
Conclusions
The change in RV s′ during low-load exercise had an incremental prognostic value for
predicting HF readmission. The results demonstrated the loss of RV contractile reserve
assessed by low-load ESE was associated with HF readmission.
Graphical abstract
Graphical Abstract
Keywords
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References
- 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC.Eur J Heart Fail. 2022; 24: 4-131
- Impending epidemic: future projection of heart failure in Japan to the year 2055.Circ J. 2008; 72: 489-491
- Temporal trends in clinical characteristics, management and prognosis of patients with symptomatic heart failure in Japan – report from the CHART studies.Circ J. 2015; 79: 2396-2407
- Consensus statement: palliative and supportive care in advanced heart failure.J Card Fail. 2004; 10: 200-209
- 24th Bethesda conference: cardiac transplantation. Task force 3: recipient guidelines/prioritization.J Am Coll Cardiol. 1993; 22: 21-31
- Association of muscular fitness with rehospitalization for heart failure with reduced ejection fraction.Clin Cardiol. 2021; 44: 244-251
- Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the heart failure Association of the European Society of cardiology.Eur J Heart Fail. 2018; 20: 16-37
- Combined right ventricular systolic and diastolic dysfunction represents a strong determinant of poor prognosis in patients with symptomatic heart failure.Int J Cardiol. 2005; 105: 164-173
- Right ventricular global longitudinal strain provides prognostic value incremental to left ventricular ejection fraction in patients with heart failure.J Am Soc Echocardiogr. 2014; 27: 726-732
- Impact of right ventricular contractile reserve during low-load exercise on exercise intolerance in heart failure.ESC Hear Fail. 2020; 7: 3810-3820
- 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.Eur Heart J. 2021; 42: 3599-3726
- Practical guidance for the implementation of stress echocardiography.J Echocardiogr. 2018; 16: 105-129
- Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.Eur Heart J Cardiovasc Imaging. 2016; 17: 1321-1360
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28: 1-39.e14
- An administrative claims measure suitable for profiling hospital performance on the basis of 30-day all-cause readmission rates among patients with heart failure.Circ Cardiovasc Qual Outcomes. 2008; 1: 29-37
- Investigation of the freely available easy-to-use software “EZR” for medical statistics.Bone Marrow Transplant. 2013; 48: 452-458
- Usefulness of the evaluation of left ventricular diastolic function changes during stress echocardiography in predicting exercise capacity in patients with ischemic heart failure.J Am Soc Echocardiogr. 2008; 21: 834-840
- Value of exercise echocardiography in heart failure with preserved ejection fraction: a substudy from the KaRen study.Eur Hear J Cardiovasc Imaging. 2016; 17: 106-113
- Substitute parameters of exercise-induced pulmonary hypertension and usefulness of low workload exercise stress echocardiography in mitral regurgitation.Sci Rep. 2022; 12: 15977
- Evaluation and management of right-sided heart failure: a scientific statement from the American Heart Association.Circulation. 2018; 137: e578-e622
- Prognostic significance of exercise-induced right ventricular dysfunction in asymptomatic degenerative mitral regurgitation.Circ Cardiovasc Imaging. 2013; 6: 167-176
- Right ventricular exercise contractile reserve and outcomes after early surgery for primary mitral regurgitation.Heart. 2018; 104: 855-860
- Right ventricular contractile reserve in mitral stenosis: implications on hemodynamic burden and clinical outcome.Int J Cardiol. 2009; 135: 193-201
- Right vs. left ventricular contractile reserve in one-year prognosis of patients with idiopathic dilated cardiomyopathy: assessment by dobutamine stress echocardiography.Eur J Echocardiogr. 2005; 6: 429-434
- Independent and additive prognostic value of right ventricular systolic function and pulmonary artery pressure in patients with chronic heart failure.J Am Coll Cardiol. 2001; 37: 183-188
- Right ventricular contractile reserve and pulmonary circulation uncoupling during exercise challenge in heart failure: pathophysiology and clinical phenotypes.JACC Heart Fail. 2016; 4: 625-635
- RV myocardial strain during pre-load augmentation is associated with exercise capacity in patients with chronic HF.JACC Cardiovasc Imaging. 2017; 10: 1240-1249
- Feasibility and role of right ventricular stress echocardiography in adult patients.J Cardiovasc Echogr. 2021; 31: 68-72
- Echocardiographic assessment of right ventricular contractile reserve in healthy subjects.Echocardiography. 2017; 34: 61-68
- Applicability of the heart failure readmission risk score: a first European study.Int J Cardiol. 2017; 236: 304-309
Article info
Publication history
Published online: March 17, 2023
Accepted:
February 17,
2023
Received in revised form:
February 13,
2023
Received:
December 9,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
