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The added value of exercise stress echocardiography in patients with heart failure

The American Journal of Cardiology Feb 15, 2019

Fabiani I, et al. - In this study that included 105 heart failure (HF) patients with reduced left ventricular ejection fraction (EF 30 ± 7%), researchers investigated whether simultaneous assessment of cardiac index (CI) and lung ultrasound (LUS) during exercise stress echocardiography (ESE) could define HF outpatients with different risk of adverse outcome. They assessed CI and B-lines at baseline and peak exercise and assessed resting plasma BNP levels. Four profiles of patients were defined: (A) peak CI ≥ 4.0 l/min/m2 and peak B-lines < 15 (no evidence of congestion or hypoperfusion, n=47); (B) peak CI ≥ 4.0 l/min/m2 and peak B-lines ≥ 15 (congestion with adequate perfusion; n=23); (C) peak CI < 4.0 l/min/m2 and peak B-lines < 15 (hypoperfusion without congestion; n=13); and (D) peak CI < 4.0 l/min/m2 and peak B-lines ≥ 15 (congestion and hypoperfusion; n=22). Findings revealed a worse survival in patients with ESE-derived D profile, followed by patients with C, B, and A profiles. For risk stratification of HF patients with reduced EF, the utility of dual evaluation of CI and LUS during ESE was evident. A subgroup with a very high risk of adverse outcome was detected by the evidence of pulmonary congestion and low CI at peak ESE.

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