PURPOSE: The aim of our study was to acquire non-invasive data from coronary flow velocity profiles during exercise in groups of healthy subjects and of patients with arterial hypertension. MATERIAL AND METHODS: We enrolled 83 patients into two groups: (1) 35 non-selected consecutive healthy subjects; (2) 25 consecutive patients with arterial hypertension. All the patients performed supine bicycle symptoms-limited tests. Throughout exercise the diastolic peaks of coronary flow velocity in LAD were recorded. Coronary flow velocity reserve (CFVR) was calculated off-line. Profiles of coronary artery velocity were acquired for all groups. The coronary artery flow parameters investigated were comparable in healthy and hypertensive patients at every stage. RESULTS: The average diastolic velocities were 54.8 ± 12.9 vs. 51.8 ± 12.2 cm/s, at 50 W; 69.2 ± 17.1 vs 64.4 ± 19.1 cm/s at 75 W; 70.7 ± 16.4 vs. 76.1 ± 19.0 cm/s at 100 W; 80.0 ± 16.0 vs. 72.9 ± 16.1 cm/s at 125 W; 83.7 ± 12.2 vs. 81.4 ± 17.0 at 150 W, p- non-significant, respectively. On average, the healthy group reached CFVR > 2.0 at a heart rate of 110-120 beats/min at 75 W. During supine bicycle exercise, healthy subjects and patients with arterial hypertension have a similar coronary artery flow velocity profile. CONCLUSION: The routine exercise echocardiography test can feasibly be supplemented with the additional measurement of coronary flow velocity during routine supine exercise stress tests, as the normal range of CFVR is reached before submaximal heart rate.

• Klíčová slova
• Coronary flow reserve, arterial hypertension, coronary velocity, exercise echocardiography, transthoracic coronary artery echo,
• MeSH
• echokardiografie MeSH
• hypertenze * MeSH
• koronární cévy * diagnostické zobrazování   MeSH
• koronární cirkulace fyziologie   MeSH
• lidé MeSH
• rychlost toku krve fyziologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

AIMS: Few data are available on the exercise-induced abnormalities of myocardial function in patients with exertional dyspnoea and normal left ventricular ejection fraction (LV EF). The main aims of this study were to determine the prevalence of isolated exercise-induced heart failure with normal ejection fraction (HFNEF) and to assess whether disturbances in LV or right ventricular longitudinal systolic function are associated with the diagnosis of HFNEF. METHODS AND RESULTS: Eighty-four patients with exertional dyspnoea and normal LV EF and 14 healthy controls underwent spirometry, NT-proBNP plasma analysis, and exercise echocardiography. Doppler LV inflow and tissue mitral and tricuspid annular velocities were analysed at rest and immediately after the termination of exercise. Of the 30 patients with the evidence of HFNEF, 6 (20%) patients had only isolated exercise-induced HFNEF. When compared with the remaining patients, those with HFNEF had a significantly lower resting and exercise peak mitral annular systolic velocity (Sa) and the mitral annular velocity during atrial contraction, lower exercise peak mitral annular velocity at early diastole, and lower exercise peak systolic velocity of tricuspid annular motion. The multivariate logistic regression analysis including both parameters standardly defining HFNEF and the new Doppler variables potentially associated with the diagnosis of HFNEF revealed that NT-proBNP, LV mass index, left atrial volume index, and Sa significantly and independently predict the diagnosis of HFNEF. CONCLUSION: A significant proportion of patients require exercise to diagnose HFNEF. Sa appears to be a significant independent predictor of HFNEF, which may increase the diagnostic value of models utilizing the variables recommended by the European Society of Cardiology guidelines.

• MeSH
• cvičení fyziologie   MeSH
• dopplerovská echokardiografie přístrojové vybavení   MeSH
• dyspnoe diagnóza   diagnostické zobrazování   etiologie   MeSH
• funkce levé komory srdeční fyziologie   MeSH
• hemodynamika MeSH
• lidé středního věku MeSH
• lidé MeSH
• natriuretický peptid typu B krev   MeSH
• odds ratio MeSH
• peptidové fragmenty krev   MeSH
• plocha pod křivkou MeSH
• prevalence MeSH
• prognóza MeSH
• rizikové faktory MeSH
• senioři MeSH
• srdeční selhání diagnóza   diagnostické zobrazování   MeSH
• tepový objem fyziologie   MeSH
• tolerance zátěže MeSH
• ukazatele zdravotního stavu MeSH
• zátěžový test přístrojové vybavení   metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• natriuretický peptid typu B MeSH
• peptidové fragmenty MeSH
• pro-brain natriuretic peptide (1-76) MeSH Prohlížeč

BACKGROUND: Noninvasive diagnosis of exercise-induced elevation of left ventricular filling pressure is difficult and remains unsatisfactory. The aim of this study was to assess the accuracy of the ratio of early diastolic transmitral (E) to mitral annular (e') velocity and to determine new parameters or parameter combinations with the ability to predict exercise-induced left atrial pressure (LAP) elevation. METHODS AND RESULTS: Eighty patients with paroxysmal atrial fibrillation (AF) referred for catheter AF ablation underwent simultaneous exercise echocardiography and direct invasive LAP measurements, as well as a resting and postexercise biomarker analysis. Exercise E/e' ≥8.85 predicted exercise LAP ≥20 mm Hg with 61.5% sensitivity and 88.9% specificity (area under the curve [AUC], 0.76). Of all of the individual parameters tested, the best prediction was achieved with exercise E/s' (s'=peak systolic mitral annular velocity) ≥8.75 (sensitivity, 88.5%; specificity, 64.8%; positive predictive value, 54.8%; negative predictive value, 92.1%; AUC, 0.84). However, the combination of exercise E/A (A = late diastolic transmitral flow velocity) ≥1.22 + exercise E/e' ≥8.85 + exercise s'≤11.05 cm/s provided the most precise prediction of exercise LAP elevation (sensitivity, 84.6%; specificity, 79.6%; positive predictive value, 66.7%; negative predictive value, 91.5%; AUC, 0.90). CONCLUSIONS: Exercise E/e', when used as a sole parameter, was not sufficiently reliable to predict exercise-induced elevation of LAP. The application of a multivariate-adjusted combination of parameters appeared to be the preferable approach for the noninvasive prediction of exercise LAP elevation.

• Klíčová slova
• biomarkers, exercise left atrial pressure, exercise mitral E/e′ ratio,
• MeSH
• cvičení fyziologie   MeSH
• diastola MeSH
• echokardiografie metody   MeSH
• fibrilace síní diagnóza   patofyziologie   MeSH
• funkce levé komory srdeční fyziologie   MeSH
• komorový tlak (srdce) fyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mitrální chlopeň diagnostické zobrazování   patofyziologie   MeSH
• prediktivní hodnota testů MeSH
• reprodukovatelnost výsledků MeSH
• rychlost toku krve MeSH
• systola MeSH
• tepový objem fyziologie   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

AIM: Determination of the importance of exercise tissue Doppler echocardiography in prognostic stratification of congestive heart failure patients with systolic dysfunction. METHODS: 106 patients with congestive heart failure and LVEF ≤ 45% on optimal pharmacotherapy were included in the study. Results of resting and post-exercise echocardiography, cardiopulmonary exercise test and serum BNP levels were available for all patients. Two patient groups were constituted, based on the prognostic classification. Group I contained 21 patients with poor prognosis (defined by predicted value of pVO2 < 76% together with both VE/VCO2 slope > 32.7 and BNP > 210 pg/mL) and group II with 85 patients who did not meet the criteria. RESULTS: The patient groups significantly differed in indexed volume of left atrium, mitral regurgitation severity, rest and post-exercise systolic velocity of mitral annulus and in rest and post-exercise E/Em. Multivariate analysis identified E/Em as the only independent predictor of prognosis. E/Em at rest (post-exercise) ≥ 16.6 (≥ 18.7) defined poor prognosis with sensitivity of 71% (86%) and specificity of 71% (71%). CONCLUSION: Our study suggests usefulness of exercise tissue Doppler echocardiography for prognostic stratification of patients with congestive heart failure with possible superiority to resting parameters.

• MeSH
• biologické markery krev   MeSH
• dopplerovská echokardiografie metody   MeSH
• dysfunkce levé srdeční komory krev   diagnostické zobrazování   MeSH
• hodnocení rizik MeSH
• lidé středního věku MeSH
• lidé MeSH
• natriuretické látky krev   MeSH
• natriuretický peptid typu B krev   MeSH
• odpočinek MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• srdeční selhání krev   diagnostické zobrazování   MeSH
• zátěžový test * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• biologické markery MeSH
• natriuretické látky MeSH
• natriuretický peptid typu B MeSH

OBJECTIVES: In stress echocardiography (SE), dipyridamole (DIP) and dynamic stress (ExSE) are reported as being safer than dobutamine stress echocardiography (DSE). We investigated whether these commonly used stressors cause myocardial injury, measured by high sensitivity troponin T (hsTnT). METHODS: One hundred and thirty five patients (DSE n = 46, ExsE n = 46, DIP n = 43) with negative result of SE were studied. The exclusion criteria were known ischaemic heart disease (IHD), baseline wall motion abnormalities, left ventricle systolic dysfunction/regional wall motion abnormalities, septum/posterior wall ≥13 mm, diabetes/pre-diabetes, baseline hsTnT level ≥14 ng/L, baseline blood pressure ≥160/100 mmHg, peak pulmonary pressure ≥45mmHg, eGFR <1ml/s/1.73m2 , more than mild to moderate valvular disease and dobutamine side effects. HsTnT was measured before and 180 minutes after the test. RESULTS: All patients had low pre-test probabilities of having obstructive IHD. HsTnT increased in DSE, less so in ExSE, and was unchanged in the DIP group (∆hsTnT 9.4 [1.5-58.6], 1.1 [-0.9-15.7], -0.1 [-1.4-2.1] ng/L, respectively, p<0.001). In DSE, the ∆hsTnT was associated with peak dobutamine dose (r = 0.30, p = 0.045), test length (r = 0.43, p = 0.003) and atropine use (p<0.001). In ExSE, the hsTnT increase was more likely in females (p = 0.012) and the elderly (>65 years) (r = 0.32, p = 0.03); no association was found between atropine use (p = 0.786) or test length and ∆hsTnT (r = 0.10, p = 0.530). CONCLUSIONS: DSE is associated with myocardial injury in patients with negative SE, no injury was observed in DIP and only mild case in ExSE. Whether myocardial injury is causative of the higher reported adverse event rates in DSE remains to be determined.

• Klíčová slova
• hsTnT, myocardial injury, negative stress echocardiography,
• MeSH
• deriváty atropinu MeSH
• dipyridamol MeSH
• dobutamin MeSH
• echokardiografie MeSH
• ischemická choroba srdeční * komplikace   MeSH
• kardiotonika MeSH
• lidé MeSH
• nemoci koronárních tepen * komplikace   MeSH
• senioři MeSH
• senzitivita a specificita MeSH
• zátěžová echokardiografie MeSH
• zátěžový test MeSH
• Check Tag
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• deriváty atropinu MeSH
• dipyridamol MeSH
• dobutamin MeSH
• kardiotonika MeSH

BACKGROUND: A significant proportion of patients with exertional dyspnea require exercise to diagnose heart failure with normal ejection fraction (HFNEF). METHODS AND RESULTS: In this review article, we evaluate current data on the prevalence, clinical significance and specifically the establishment of a diagnosis of isolated, exercise-induced HFNEF. Despite the unquestioned clinical importance and high prevalence of exercise-induced HFNEF, there are limited and conflicting data on making a diagnosis of exercise-induced HFNEF. This mostly relies on the evidence of exercise-induced elevation in left ventricular filling pressure (LVFP). At present, there is no agreement on the ability of exercise echocardiographic parameteres to predict exercise-induced LVFP elevation. In addition, even invasively measured exercise LVFP faces the problem of defining normal exercise LVFP values. More data and probably new diagnostic approaches are necessary to reliably diagnose exercise HFNEF. CONCLUSIONS: There are conflicting results and significant problems associated with the diagnosis of exercise HFNEF. This review hopefully will encourage further research in this difficult but clinically important area of heart failure.

• Klíčová slova
• exercise echocardiography, heart failure with normal ejection fraction, left ventricular filling pressure,
• MeSH
• barevná dopplerovská echokardiografie MeSH
• cvičení fyziologie   MeSH
• dysfunkce levé srdeční komory diagnóza   patofyziologie   MeSH
• dyspnoe etiologie   MeSH
• krevní tlak fyziologie   MeSH
• lidé MeSH
• srdeční selhání diagnóza   patofyziologie   MeSH
• tepový objem fyziologie   MeSH
• zátěžová echokardiografie MeSH
• zátěžový test MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• přehledy MeSH

INTRODUCTION: Identification of elevated pulmonary artery pressures during exercise has important diagnostic, prognostic and therapeutic implications. Stress echocardiography is frequently used to estimate pulmonary artery pressures during exercise testing, but data supporting this practice are limited. This study examined the accuracy of Doppler echocardiography for the estimation of pulmonary artery pressures at rest and during exercise. METHODS: Simultaneous cardiac catheterisation-echocardiographic studies were performed at rest and during exercise in 97 subjects with dyspnoea. Echocardiography-estimated pulmonary artery systolic pressure (ePASP) was calculated from the right ventricular (RV) to right atrial (RA) pressure gradient and estimated RA pressure (eRAP), and then compared with directly measured PASP and RAP. RESULTS: Estimated PASP was obtainable in 57% of subjects at rest, but feasibility decreased to 15-16% during exercise, due mainly to an inability to obtain eRAP during stress. Estimated PASP correlated well with direct PASP at rest (r=0.76, p<0.0001; bias -1 mmHg) and during exercise (r=0.76, p=0.001; bias +3 mmHg). When assuming eRAP of 10 mmHg, ePASP correlated with direct PASP (r=0.70, p<0.0001), but substantially underestimated true values (bias +9 mmHg), with the greatest underestimation among patients with severe exercise-induced pulmonary hypertension (EIPH). Estimation of eRAP during exercise from resting eRAP improved discrimination of patients with or without EIPH (area under the curve 0.81), with minimal bias (5 mmHg), but wide limits of agreement (-14-25 mmHg). CONCLUSIONS: The RV-RA pressure gradient can be estimated with reasonable accuracy during exercise when measurable. However, RA hypertension frequently develops in patients with EIPH, and the inability to noninvasively account for this leads to substantial underestimation of exercise pulmonary artery pressures.

• MeSH
• arteria pulmonalis * diagnostické zobrazování   MeSH
• cvičení MeSH
• dopplerovská echokardiografie MeSH
• lidé MeSH
• plicní hypertenze * diagnostické zobrazování   MeSH
• zátěžová echokardiografie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Research Support, N.I.H., Extramural MeSH

The study concerned the possibility of using echocardiography after hyperbaric oxygenation (HBO2) to detect viable myocardium. Results were compared with dobutamine stress echocardiography (DSE). Seventeen patients with left ventricular dysfunction were enrolled in this study. The regional wall motion of the left ventricle was assessed for every patient and a wall motion score index was calculated. A resting wall motion abnormality was found in 204 segments (75%), of which 119 segments (58%) improved during DSE, and 59 (29%) after HBO2. Of 119 segments with evidence of viability in DSE, HBO2 showed viability in 58 segments. Of 85 segments non-viable in DSE, 84 segments were also non-viable after HBO2. The positive and negative predictive values of HBO2 compared to DSE were 98 and 58%, respectively. Comparing the wall motion score index at rest with the index after DSE 5 and 10 micrograms.kg-1.min-1 dobutamine and after HBO2, there was significant improvement (P < 0.005). Differences between DSE 5 micrograms.kg-1.min-1 dobutamine and DSE 10 micrograms.kg-1.min-1 dobutamine and between HBO2 and DSE 10 micrograms.kg-1.min-1 dobutamine were also significant (P < 0.005). There was no significant difference between DSE 5 micrograms.kg-1.min-1 and HBO2. Echocardiography after HBO2 is a new method for the detection of viable myocardium. It appears similar in accuracy to DSE 5 micrograms.kg-1.min-1, but is inferior to DSE 10 micrograms.kg-1.min-1.

• MeSH
• dobutamin MeSH
• dysfunkce levé srdeční komory diagnostické zobrazování   patofyziologie   MeSH
• echokardiografie * MeSH
• hyperbarická oxygenace * MeSH
• infarkt myokardu diagnostické zobrazování   patofyziologie   terapie   MeSH
• kardiotonika MeSH
• kontrakce myokardu * MeSH
• lidé středního věku MeSH
• lidé MeSH
• senzitivita a specificita MeSH
• zátěžový test MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Názvy látek
• dobutamin MeSH
• kardiotonika MeSH

In their generally designed presentation the authors focus on practical problems concerning indication, different stress modalities and projections, evaluation and interpretation of findings, as well as on technical novelties and their use. Only dynamic exercise echocardiography is being discussed. Currently available knowledge is assessed in the light of the authors' own experience. Problems of evaluation and interpretation are considered to be most intricate. In the authors' opinion, many technical problems which have prevented the routine use of the method in practice will be eliminated by introducing technical novelties such as digitalization of the display with image loop. Other innovations will certainly be used to advantage and render the method less demanding and far more widespread.

• MeSH
• echokardiografie metody   MeSH
• lidé MeSH
• zátěžový test * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• anglický abstrakt MeSH
• časopisecké články MeSH

BACKGROUND: Assessment of coronary flow is only performed during pharmacological tests. Supine bicycle tests permit the visualization of coronary flow assessments during exercise. PURPOSE: To assess the parameters of coronary flow in the left anterior descending artery (LAD) during exercise, which could be a sign of significant LAD narrowing. MATERIAL AND METHODS: A total of 253 patients were enrolled: Group 1, 186 non-selective participants before undergoing a coronary angiography; and Group 2, 67 controls without coronary artery disease (CAD). All the patients performed a supine bicycle echocardiography test. Coronary flow velocities and coronary flow velocity reserve (CFVR) were measured at the mid-segment of the LAD during exercise. Patients in Group 1 underwent a coronary angiography. RESULTS: In comparison with participants without significant LAD stenosis, patients with LAD lesions had a lower ΔV (16 ± 21 vs. 27 ± 20 cm/s, P < 0.04) and a lower CFVR (1.5 ± 0.8 vs. 2.0 ± 0.6, P < 0.004). In comparison with patients without significant proximal LAD stenosis, the patients with proximal LAD lesions had a lower flow velocity at the peak of exercise (49 ± 32 vs. 61 ± 19 cm/s, P < 0.02), a lower ΔV (13 ± 19 vs. 26 ± 22 cm/s, P < 0.004), and a lower CFVR (1.4 ± 0.6 vs. 1.9 ± 0.7, P < 0.0001). In comparison with the control group, the patients with LAD stenosis had a lower flow velocity at the peak of exercise, a lower ΔV, and a lower CFVR. CONCLUSION: Non-invasive CFVR measurement in the LAD could provide valuable additional information to a conventional echocardiography exercise test. In routine clinical practice, CFVR is sufficient for a diagnosis of severe stenosis.

• Klíčová slova
• Coronary flow reserve, LAD flow, coronary flow velocity, exercise echo, visualization of coronary artery,
• MeSH
• cyklistika fyziologie   MeSH
• koronární angiografie MeSH
• koronární cirkulace * MeSH
• koronární nemoc diagnostické zobrazování   patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• pulzní dopplerovská echokardiografie * MeSH
• rychlost toku krve * MeSH
• studie případů a kontrol MeSH
• zátěžová echokardiografie * MeSH
• zátěžový test * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH