Clinical Significance of Using Stress Echocardiography for Cardiovascular Rehabilitation

Summary

Here, we present a protocol to measure cardiac function during exercise, using the stress echocardiography method in patients with heart failure. We then discuss the relevance of this method for clinicians and patients to develop its use in the clinical context.

Abstract

Studies performed in humans and animals using exercise have yielded many insights into cardiovascular physiology and mechanisms by which the heart, the myocardium, and the vessels respond to exercise stress. One of the clinical interests of stress echocardiography (SE) is to find slight dysfunctions that cannot be seen during routine exams at rest. The main steps of this SE protocol begin with patient preparation (e.g., hold caffeine, beta-blockers 24 h before SE, no contraindications) and a baseline assessment, including resting echocardiographic images (2D, Doppler, and optional strain imaging) in standard views (parasternal, apical, and subcostal). Then, the stress phase follows, using exercise on a dedicated bicycle with continuous monitoring of ECG, blood pressure, symptoms, and echocardiographic images. Immediately after peak stress, post-stress imaging is performed to rapidly acquire the same views, comparing wall motion, contractility, and Doppler-derived parameters to detect changes (e.g., ischemia, wall motion abnormalities, pressures). Another interest in measuring cardiovascular function during exercise is to better understand how the heart, the myocardium, and the vessels adapt in response to stress. SE also combines functional and imaging data that can improve heart failure phenotyping, and personalized treatment to improve patient care. To maximize the reliability of future studies using exercise, it is important to provide standardized methods allowing the measurement of cardiovascular function during exercise and to provide standardized exercise protocols. In this context, the present paper will focus on patients with heart failure. The objectives of the paper are to describe the stress echocardiography method and report the practical and clinical applications and discuss the relevance of this method for clinicians and patients.

Introduction

According to the World Health Organization (WHO), heart failure (HF) is defined as a complex syndrome in which the heart is unable to pump sufficient blood to meet the body's metabolic needs¹. This condition can result from systolic dysfunction, where the heart fails to contract properly, or diastolic dysfunction, where the heart does not fill adequately². HF is classified into two main categories: heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF)³. In HFrEF, the left ventricular ejection fraction (LVEF) is <40%, indicating decr....

Protocol

The protocol described below follows the guidelines of the Université Paris Cité's human research ethics committee; written informed consent has been obtained from the patients involved.

Below is the fully detailed resting echocardiography methodology.

1. Patient preparation

1. Place the patient in a left lateral decubitus position for rest echocardiography and then install the patient on the semi-supine bicycle for SE.
2. Place the electrodes for accurate correlation with the cardiac cycle.

2. Image acquisition

<....

Results

Patients' characteristics and exercise capacity

The elements below represent examples of typical profiles of patients followed in the cardiac rehabilitation departments of the Corentin Celton and the Paris Saint Joseph hospitals.

Mr. B: 71 years old, New York Heart Association (NYHA): 2, ejection fraction: 37%
Dilated cardiomyopathy + Cardiac Resynchronization Therapy
Exercise test: 70 watts, Peak of VO₂ 14.9 mL·kg^-1·mi.......

Discussion

The findings from this study underscore the importance and utility of the SE in the comprehensive evaluation of patients with HFrEF. By employing a combination of resting echocardiography and SE, this study provides insights into the hemodynamic and functional changes that occur under stress conditions, which are often not apparent during rest.

Diagnostic value of stress echocardiography
One of the key advantages of SE over resting echocardiography is its ability to reve.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
CPX Vyntus	Vyvaire Medical	N/A	Respiratory gas exchange analyzer for cardiopulmonary exercise testing
EchoPac PC-SW 113	GE Healthcare	N/A	Software dedicated to visualize and analyze for cardiac ultrasound data
SanaBike  1.01	Ergosana - Schiller group	N/A	Bicycle ergometer
Vivid 9 Dimension	GE Healthcare	N/A	Echocardiograph