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Hypertensive response during exercise stress echocardiography: the impact on left ventricle systolic function

Authors: Karev E.A., Malev E.G., Suvorov A.Yu., Bobrova E.A., Verbilo S.L., Prokudina M.N.

Company: 1 V.A. Almazov National Medical Research Center of the Ministry of Health of the Russian Federation, Saint Petersburg, Russian Federation
2 Saint Petersburg State Pediatric Medical University of the Ministry of Health of Russia, Saint Petersburg, Russian Federation
3 Pharmaceutical company “Feron” Moscow, Russian Federation
4 International Heart Center, Saint Petersburg, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2021-15-3-354-366

For citation: Karev E.A., Malev E.G., Suvorov A.Yu., Bobrova E.A., Verbilo S.L., Prokudina M.N. Hypertensive response during exercise stress echocardiography: the impact on left ventricle systolic function. Creative Cardiology. 2021; 15 (3): 354–66 (in Russ.). DOI: 10.24022/1997-3187-2021-15-3-354-366

Received / Accepted:  29.04.2021 / 01.09.2021

Keywords: stress echocardiography strain hypertensive response to exercise dyssynchrony

Full text:  

 

Abstract

Objective. To analyze systolic strain and dyssynchrony parameters during stress echocardiography depending on the type of blood pressure (BP) response to exercise in patients without obstructive coronary disease

Material and methods. 96 patients without significant coronary artery stenosis by invasive coronary angiography or CT-coronary angiography results underwent stress echocardiography on treadmill with 2D and 3D images analysis, left ventricle global longitudinal strain (GLS) and dyssynchrony assessment at rest and on stress. Patients were divided into two groups: with normal (n = 55) and hypertensive response to exercise (n = 41) (HRE).

Results. HRE was associated with diminished increase in left ventricle 2D-ejection fraction, smaller peak exertional GLS and GLS increase, more frequent wall motion abnormalities during test (all р < 0.01). Patient’s age older than 60 years, double product > 26010 and GLS on exertion >–22% were predictors of poor GLS increase (AUC 0.843, р = 0.0002), systolic BP > 140 mm Hg at rest, 2D-ejection fraction increment < 6% and decrease in Tmsv%R-R more than 4% were predictors of transient regional wall motion abnormalities on exertion (AUC 0.87, р = 0.008). Standard deviation of time from the QRS complex onset to the peak segmental longitudinal strain and systolic BP on exertion had positive correlation (p < 0.0001).

Conclusion. Patients with HRE demonstrate higher prevalence of left ventricle systolic dysfunction and dyssynchrony during stress echocardiography even in absence of coronary artery stenosis, which can alter the specificity of the test. Medical therapy adjustment before test is crucial in patients with HRE and uncontrolled hypertension. Patient’s age and double product are independent predictors of insufficient increase in GLS.

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About Authors

  • Egor A. Karev, Functional Diagnostician, Cardiologist; ORCID
  • Ehduard G. Malev, Dr. Med. Sci., Leading Researcher of V.A. Almazov National Medical Research Center. Professor of the Department of Internal Medicine Propaedeutics of Saint Petersburg State Pediatric Medical University; ORCID
  • Aleksandr Yu. Suvorov, Cand. Med. Sci., Biostatistics Specialist; ORCID
  • Ekaterina A. Bobrova, Functional Diagnostician, Cardiologist; ORCID
  • Sergey L. Verbilo, Functional Diagnostician, Cardiologist; ORCID
  • Mariya N. Prokudina, Dr. Med. Sci., President of International Heart Center;ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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