LV cavity dilatation occurred in 5.1% of patients during SBSE, with about half having obstructive CAD associated with more severe chest pain (53.3% vs 14.3%, p=0.050) and the other half having non-obstructive CAD with hypertensive responses and increased diastolic BP and RPP at peak exercise.
Observational (n=653)
No
What are the clinical and hemodynamic characteristics associated with left ventricular cavity dilatation during supine bicycle exercise stress echocardiography?
Left ventricular cavity dilatation during supine bicycle stress echocardiography occurs in about 5% of patients, with half attributable to obstructive CAD and the other half associated with an exaggerated hypertensive response in non-obstructive coronary arteries.
Abstract Background Cavity dilatation is occasionally observed during supine bicycle exercise stress echocardiography (SBSE). The underlying mechanisms are poorly understood. Aims This study aimed to characterise patients with left ventricle (LV) cavity dilatation and a decrease in the left ventricular ejection fraction (LVEF) during SBSE. Methods A total of 653 patients who underwent SBSE were evaluated. Those with exercise-induced cavity dilatation (defined as increased cavity size and a decrease in LVEF) were evaluated ( n = 29). A control group ( n = 37) of patients with a hypertensive response and a normal ESE was also evaluated. Results A total of 33/653 (5.1%) patients had an abnormal LV cavity response to exercise, with 15/29 (51.7%) having significant underlying coronary artery disease (CAD). Comparisons were made between patients with CAD ( n = 15) and those with nonobstructive coronary arteries (NCAs, n = 14). NCA patients had significantly higher peak diastolic blood pressure (DBP) (NCA-CD 109 ± 17 mmHg vs. CAD-CD 96 ± 16 mmHg, p = 0.044) and rate-pressure product (RPP) (NCA-CD 28,623 ± 4474 vs. CAD-CD 23,649 ± 4763, p = 0.007). There was a trend toward increased dyspnoea at peak exercise in NCA (NCA-CD 35.7% vs. CAD-CD 6.7%, p = 0.080), and CAD patients showed a higher observed frequency of severe chest pain (CAD 53.3% vs. NCA 14.3%, p = 0.050). When patients with NCA and cavity dilatation were compared with a control group of patients with a hypertensive response to exercise but no cavity dilatation, no significant differences were observed. Conclusion Cavity dilatation is observed in 5% patients undergoing SBSE and is attributable to significant CAD in approximately half of patients. NCA cavity dilatation is associated with increased RPP and DBP at peak exercise, with a trend toward increased dyspnoea. Severe chest pain at peak exercise was observed more frequently in CAD patients.
Elliott et al. (Mon,) conducted a observational in Adults undergoing supine bicycle exercise stress echocardiography for suspected coronary artery disease, excluding those with prior CAD, moderate valvular disease, arrhythmias, or heart failure (n=653). Supine bicycle exercise stress echocardiography (SBSE) vs. Control group with hypertensive response and normal LV response to exercise was evaluated on Prevalence and characteristics of LV cavity dilatation during SBSE defined as increased cavity size with a decrease in LVEF. LV cavity dilatation occurred in 5.1% of patients during SBSE, with about half having obstructive CAD associated with more severe chest pain (53.3% vs 14.3%, p=0.050) and the other half having non-obstructive CAD with hypertensive responses and increased diastolic BP and RPP at peak exercise.