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Shortness of Breath on Exertion: Diagnostic Possibilities of Stress Echocardiography

https://doi.org/10.18087/cardio.2021.2.n1320

Abstract

Aim      To determine diagnostic capabilities of the expanded protocol for stress echocardiography (stress-EchoCG) with comprehensive evaluation of clinical and echocardiographic indexes in differential diagnosis of dyspnea.

Material and methods This study included 243 patients (123 women and 120 men) who were referred to outpatient stress-EchoCG during one calendar month. For 80 patients complaining about shortness of breath, the expanded stress-EchoCG protocol with treadmill exercise was performed. During the exercise, E / e’ and tricuspid regurgitation velocity were determined, and clinical features and possible nature of dyspnea were evaluated.

Results Shortness of breath had an ischemic origin in 17.5 % of 80 patients; 13.8 % had criteria of elevated left ventricular end-diastolic pressure; 17.5 % of patients had clinical signs of bronco-pulmonary pathology; 5.0 % had moderate and severe mitral regurgitation; 20 % displayed signs of chronotropic insufficiency during exercise including on the background of beta-blocker therapy; 15.0 % of patients displayed a hypertensive response to exercise, which was associated with signs of chronotropic insufficiency in 50 % of them; and 1.3 % had signs of hyperventilation syndrome. In addition to diagnosis of transient ischemia, additional information about the nature of shortness of breath was obtained for 72.5 % of patients. Based on results of the test, objective causes for dyspnea were not identified for 10.0 % of patients.

Conclusion      The expanded stress-EchoCG protocol with exercise allows obtaining information about the nature of dyspnea for most patients with shortness of breath of a non-ischemic origin. For this patient category, expanding the stress-EchoCG protocol does not increase duration of the study and is economically beneficial for diagnosis of chronic heart failure and other causes for shortness of breath.

About the Authors

E. A. Karev
V.A. Almazov National Medical Research Center of the Ministry of Health of the Russian Federation, Saint Petersburg
Russian Federation
cardiologist, functional diagnostics specialist


E. G. Malev
V.A. Almazov National Medical Research Center of the Ministry of Health of the Russian Federation, Saint Petersburg; Saint Petersburg State Pediatric Medical University of the Ministry of Health of Russia, Saint Petersburg
Russian Federation
PHD, leading research worker in  “Almazov National Medical Research Centre”, chair professor of Propaedeutics of Internal Diseases of "St. Petersburg State Pediatric Medical University"


S. L. Verbilo
V.A. Almazov National Medical Research Center of the Ministry of Health of the Russian Federation, Saint Petersburg
Russian Federation
cardiologist, functional diagnostics specialist


M. N. Prokudina
International Heart Center, Saint Petersburg
Russian Federation
PHD, cardiologist, President of "OOO International Heart Centre"


References

1. Berliner D, Schneider N, Welte T, Bauersachs J. The Differential Diagnosis of Dyspnea. Deutsches Aerzteblatt Online. 2016;113(9):834– 45. DOI: 10.3238/arztebl.2016.0834

2. Charles J, Britt H, Ng A. Management of cardiovascular conditions in Australian general practice. Australian Family Physician. 2005;34(6):410–1. PMID: 15931397

3. Parshall MB, Schwartzstein RM, Adams L, Banzett RB, Manning HL, Bourbeau J et al. An Official American Thoracic Society Statement: Update on the Mechanisms, Assessment, and Management of Dyspnea. American Journal of Respiratory and Critical Care Medicine. 2012;185(4):435–52. DOI: 10.1164/rccm.201111-2042ST

4. Vertkin A.L., Topolyanskiy A.V., Knorring G.Yu., Abdullaeva A.U. Shortness of breath on outpatient visit. Russian Medical Journal. 2017;25(4):290–5.

5. Elliott MW, Adams L, Cockcroft A, Macrae KD, Murphy K, Guz A. The Language of Breathlessness: Use of Verbal Descriptors by Patients with Cardiopulmonary Disease. American Review of Respiratory Disease. 1991;144(4):826–32. DOI: 10.1164/ajrccm/144.4.826

6. Bergeron S, Ommen SR, Bailey KR, Oh JK, McCully RB, Pellikka PA. Exercise echocardiographic findings and outcome of patients referred for evaluation of dyspnea. Journal of the American College of Cardiology. 2004;43(12):2242–6. DOI: 10.1016/j.jacc.2004.03.033

7. Argulian E, Halpern DG, Agarwal V, Agarwal SK, Chaudhry FA. Predictors of Ischemia in Patients Referred for Evaluation of Exertional Dyspnea: A Stress Echocardiography Study. Journal of the American Society of Echocardiography. 2013;26(1):72–6. DOI: 10.1016/j.echo.2012.09.012

8. Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R et al. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. European Heart Journal – Cardiovascular Imaging. 2016;17(11):1191–229. DOI: 10.1093/ehjci/jew190

9. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal. 2016;37(27):2129–200. DOI: 10.1093/eurheartj/ehw128

10. Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography. 2016;29(4):277–314. DOI: 10.1016/j.echo.2016.01.011

11. Lewis RA, Howell JB. Definition of the hyperventilation syndrome. Bulletin Europeen De Physiopathologie Respiratoire. 1986;22(2):201–5. PMID: 3708188

12. Pfortmueller CA, Pauchard-Neuwerth SE, Leichtle AB, Fiedler GM, Exadaktylos AK, Lindner G. Primary Hyperventilation in the Emergency Department: A First Overview. PLOS ONE. 2015;10(6):e0129562. DOI: 10.1371/journal.pone.0129562

13. Lauer MS, Francis GS, Okin PM, Pashkow FJ, Snader CE, Marwick TH. Impaired Chronotropic Response to Exercise Stress Testing as a Predictor of Mortality. JAMA. 1999;281(6):524–9. DOI: 10.1001/jama.281.6.524

14. Azarbal B, Hayes SW, Lewin HC, Hachamovitch R, Cohen I, Berman DS. The incremental prognostic value of percentage of heart rate reserve achieved over myocardial perfusion single-photon emission computed tomography in the prediction of cardiac death and all-cause mortality. Journal of the American College of Cardiology. 2004;44(2):423–30. DOI: 10.1016/j.jacc.2004.02.060

15. Lauer MS, Levy D, Anderson KM, Plehn JF. Is There a Relationship between Exercise Systolic Blood Pressure Response and Left Ventricular Mass? The Framingham Heart Study. Annals of Internal Medicine. 1992;116(3):203–10. DOI: 10.7326/0003-4819-116-3-203

16. Weiss SA, Blumenthal RS, Sharrett AR, Redberg RF, Mora S. Exercise Blood Pressure and Future Cardiovascular Death in Asymptomatic Individuals. Circulation. 2010;121(19):2109–16. DOI: 10.1161/CIRCULATIONAHA.109.895292

17. Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA et al. Recommendations for Noninvasive Evaluation of Native Valvular Regurgitation: A Report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. Journal of the American Society of Echocardiography. 2017;30(4):303–71. DOI: 10.1016/j.echo.2017.01.007

18. Sicari R, Cortigiani L. The clinical use of stress echocardiography in ischemic heart disease. Cardiovascular Ultrasound. 2017;15(1):7. DOI: 10.1186/s12947-017-0099-2

19. Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, FunckBrentano C et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. European Heart Journal. 2020;41(3):407–77. DOI: 10.1093/eurheartj/ehz425

20. Pellikka PA, Arruda-Olson A, Chaudhry FA, Chen MH, Marshall JE, Porter TR et al. Guidelines for Performance, Interpretation, and Application of Stress Echocardiography in Ischemic Heart Disease: From the American Society of Echocardiography. Journal of the American Society of Echocardiography. 2020;33(1):1-41.e8. DOI: 10.1016/j.echo.2019.07.001

21. Dzhioeva O.N., Drapkina O.M. Diastolic stress test in the preoperative non-cardiac surgery examination. Russian Journal of Cardiology. 2020;25(S3):35–9. DOI: 10.15829/1560-4071-2020-3986


Review

For citations:


Karev E.A., Malev E.G., Verbilo S.L., Prokudina M.N. Shortness of Breath on Exertion: Diagnostic Possibilities of Stress Echocardiography. Kardiologiia. 2021;61(2):62-68. https://doi.org/10.18087/cardio.2021.2.n1320

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ISSN 0022-9040 (Print)
ISSN 2412-5660 (Online)