Efficiency of bending test and spectral tracking echocardiography in diagnosis of heart failure with preserved ejection fraction
AbstractDue to the steady increase in the incidence and hospitalization of patients with heart failure (HF), with the predominance of the HF with a preserved ejection fraction form (HFpEF), it is necessary to search for new methods of its early diagnosis with high accuracy, good reproducibility, low cost and ease of implementation at the outpatient stage. Modern imaging techniques such as spectral tracking echocardiography (STE) at rest and with the performance of functional tests can be the optimal solution to this problem.
The aim of this study was to determine the applicability of the new imaging techniques and bending test (BT) for the diagnosis of HFpEF.
Material. 45 patients with HFpEF and 39 subjects of the control group underwent transthoracic speckle tracking echocardiography (STE) with simultaneous recording of an electrocardiogram (ECG) at rest and during BT.
Methods. Each study participant was asked to lean forward at the waist from a sitting position as if he or she was wearing socks or shoes. During the test, transthoracic echocardiography and STE were performed with simultaneous registration ECG at rest and with BT. In addition, the researcher recorded the time from the beginning of the test to the appearance of flexodispnea in accordance with the indications of the subject, who was defined as suffering from bendopnea if he complained on shortness of breath or its equivalents for 30 seconds or more after bending.
Results. A significant increase in the size of the left atrium (LA) and its volume index was revealed in patients with HFpEF compared with the control group. During the test, there was a significant increase in heart rate (HR) and a decrease in the left ventricular ejection fraction in patients with this pathology compared to healthy people.
Deviations in myocardial deformation indicators were more obvious when measurements were carried out during the test compared with rest. An increase in the prognostic significance of these parameters during their evaluation in BT can serve as a basis for the inclusion of this research method in the early diagnosis and prognostic evaluation of HFpEF.
When performing BT, changes in the longitudinal deformation of the left ventricular due to a decrease in preload is heterogeneous: while some subjects have an increase or decrease in this indicator, in others it remains stable.
The diagnostic imporatance of the test is confirmed by the observed statistically significant differences between patients with HFpEF and the control group. At the same time, in the working group, the average value of myocardial deformation indicators by segments is significantly lower than in the control group.
Conclusion. STE with BT is an effective non-invasive, widely available and easily reproducible outpatient diagnostic method of HFpEF.
Keywords:heart failure; preserved ejection fraction; strain; bending test; exercise; bendopnea
Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Serezhina E.K., Obrezan A.G. Efficiency of bending test and spectral tracking echocardiography in diagnosis of heart failure with preserved ejection fraction. Kardiologiya: novosti, mneniya, obuchenie [Cardiology: News, Opinions, Training]. 2022; 10 (1): 22-8. DOI: https://doi.org/10.33029/2309-1908-2022-10-1-22-28 (in Russian)
References
1. Benjamin E.J., Muntner P., Alonso A., Bittencourt M.S., Callaway C.W., Carson A.P., et al.; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: a report from the American Heart Association. Circulation. 2019; 139 (10): e56-528.
2. Ratchford S.M., Clifton H.L., La Salle D.T., Broxterman R.M., Lee J.F., Ryan J.J., et al. Cardiovascular responses to rhythmic handgrip exercise in heart failure with preserved ejection fraction. J Appl Physiol. 2020; 129 (6): 1267-76. DOI: https://doi.org/10.1152/japplphysiol.00468.2020
3. Serezhina E.K., Obrezan A.G. New imaging techniques in the diagnosis of heart failure with preserved ejection fraction. Rossiyskiy meditsinskiy zhurnal. Meditsinskoe obozrenie [Russian Medical Journal. Medical Review]. 2019; 1 (II): 52-6. (in Russian)
4. Baeza-Trinidad R., Mosquera-Lozano J.D., El Bikri L. Assessment of bendopnea impact on decompensated heart failure. Eur J Heart Fail. 2017; 19: 111-5. DOI: https://doi.org/10.1002/ejhf.610
5. McKee P.A., Castelli W.P., McNamara P.M., Kannel W.B. The natural history of congestive heart failure: the Framingham study. N Engl J Med. 1971; 285: 1441-6.
6. Thibodeau J.T., Turer A.T., Gualano S.K., Ayers C.R., Velez-Martinez M., Mishkin J.D., et al. Characterization of a novel symptom of advanced heart failure: bendopnea. JACC Heart Fail. 2014; 2 (1): 24-31. DOI: https://doi.org/10.1016/j.jchf.2013.07.009
7. Thibodeau J.T., Jenny B.E., Maduka J.O., Divanji P.H., Ayers C.R., Araj F., et al. Bendopnea and risk of adverse clinical outcomes in ambulatory patients with systolic heart failure. Am Heart J. 2017; 183: 102-7.
8. Pranata R., Yonas E., Chintya V., Alkatiri A.A., Budi Siswanto B. Clinical significance of bendopnea in heart failure - systematic review and meta-analysis Indian Heart J. 2019; 71 (3): 277-83.
9. Larina V.N., Bart B.Ya., Chukaeva I.I., Karpenko D.G., Zacharova M.I., Kulbachinskaya O.M. Bendopnea: association with echocardiographic features and clinical outcomes in elderly patients with chronic heart failure. Kardiologiia [Cardiology]. 2018; 58 (12): 36-44. DOI: https://doi.org/10.18087/cardio.2018.12.10190 (in Russian)
10. Kapłon-Cieślicka A., Kupczyńska K., Dobrowolski P., Michalski B., Jaguszewski M.J., Banasiak W., et al.; "Club 30" of The Polish Cardiac Society. On the search for the right definition of heart failure with preserved ejection fraction. Cardiol J. 2020; 27 (5): 449-68. DOI: https://doi.org/10.5603/CJ.a2020.0124
11. Smiseth O.A., Torp H., Opdahl A., Haugaa K.H., Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J. 2016; 37 (15): 1196-207. DOI: https://doi.org/10.1093/eurheartj/ehv529
12. Blum M., Hashemi D., Motzkus L.A., Neye M., Dordevic A., Zieschang V., et al. Variability of myocardial strain during isometric exercise in subjects with and without heart failure. Front Cardiovasc Med. 2020; 7: 111. DOI: https://doi.org/10.3389/fcvm.2020.00111
13. Mitchell C., Rahko P.S., Blauwet L.A., Canaday B., Finstuen J.A., Foster M.C., et al. Guidelines for performing a comprehensive transthoracic echocardiographic examination in adults: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019; 32 (1): 1-64. DOI: https://doi.org/10.1016/j.echo.2018.06.004 Epub 2018 Oct 1. PMID: 30282592