title: Echocardiography and invasive hemodynamics during stress testing for diagnosis of heart failure with preserved ejection fraction: an experimental study.
abstract: 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°), 5 μg·Kg(-1)·min(-1) dobutamine, and 7.5 μg·Kg(-1)·min(-1) phenylephrine with simultaneous left ventricular (LV) pressure-volume loop and echocardiography evaluation under halogenate anesthesia. Effort testing with maximum O2 consumption (V̇o 2 max) determination was performed 1 wk later. Obese ZSF1 showed lower effort tolerance and V̇o 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.
authors: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal;
authors: Sara
authors: S
authors: Leite
authors: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal;
authors: José
authors: J
authors: Oliveira-Pinto
authors: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Cardiology, Hospital São João, Porto, Portugal;
authors: Marta
authors: M
authors: Tavares-Silva
authors: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal;
authors: Mahmoud
authors: M
authors: Abdellatif
authors: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal;
authors: Dulce
authors: D
authors: Fontoura
authors: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal;
authors: Inês
authors: http://orcid.org/0000-0003-1937-3782
authors: I
authors: Falcão-Pires
authors: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Cardiothoracic Surgery, Hospital São João, Porto, Portugal;
authors: Adelino F
authors: AF
authors: Leite-Moreira
authors: Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal; Department of Anesthesiology, Hospital São João, Porto, Portugal aplourenco@yahoo.com.
authors: André P
authors: http://orcid.org/0000-0002-5756-9535
authors: AP
authors: Lourenço
mesh_terms: D000818:Animals; D019540:Area Under Curve; D006328:Cardiac Catheterization; D004195:Disease Models, Animal; D004280:Dobutamine; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D017079:Exercise Tolerance; D005240:Feasibility Studies; D018475:Head-Down Tilt; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D006439:Hemodynamics; D008297:Male; D009765:Obesity / Q000150:complications; D010101:Oxygen Consumption; D010656:Phenylephrine; D011237:Predictive Value of Tests; D012372:ROC Curve; D011921:Rats, Inbred WKY; D011924:Rats, Zucker; D015203:Reproducibility of Results; D013318:Stroke Volume; D013997:Time Factors; D016277:Ventricular Function, Left; D017725:Ventricular Pressure
chemical_list: D010656:Phenylephrine; D004280:Dobutamine
keywords: diagnosis; echocardiography; heart failure with preserved ejection fraction; hemodynamics; stress