Pre-Load Stress Echo Benefits Heart Failure Prediction
(HealthDay News) — Pre-load stress echocardiography using leg-positive pressure (LPP) provides additional prognostic information beyond that provided by conventional Doppler echocardiography at rest in cases of mild heart failure, according to a study published online June 18 in JACC: Cardiovascular Imaging.
Hirotsugu Yamada, MD, PhD, from Tokushima University Hospital in Japan, and colleagues performed transthoracic echocardiography with LPP in 202 patients with chronic cardiac disease. Patients were categorized based on left ventricular (LV) diastolic dysfunction using transmitral flow velocity as: restrictive or pseudonormal (PN) at rest, impaired relaxation (IR) at rest and during LPP (stable IR), and IR at rest and PN during LPP (unstable IR).
The researchers found that LPP increased LV end-diastolic pressure from 15.8 to 20.5mmHg in the unstable IR group and from 10.5 to 14.7mmHg in the stable IR group (both P<0.001). Over an average of 548 days of follow-up, 5 patients had cardiac death, 37 had acute heart failure, 4 had an acute myocardial infarction, and 7 had a stroke. In unstable IR the all-cause cardiac event rate was higher than in stable IR (P<0.001), and was similar in the PN group (P=0.81). Similarly, in the unstable IR group event-free survival was significantly lower vs. in stable IR (P=0.003). Unstable IR was an independent predictor of all-cause cardiac events (hazard ratio: 8.0; P<0.001).
"Pre-load stress echocardiography using LPP provides additional prognostic information in mild heart failure beyond that provided by conventional Doppler echocardiography at rest," the authors write.