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A highlight of today’s programme is a live case transmission broadcast from the cardiopulmonary imaging laboratory at IRCCS Policlinico San Donato, Milan.
One of our session hosts, Professor Marco Guazzi, will begin by explaining the theory and evidence base that supports combining cardiopulmonary exercise testing (CPET) with stress echocardiography in this relatively new application of CPET imaging.1
Prof. Guazzi explains, “CPET and gas exchange analysis allows us to investigate and quantify exercise intolerance and the impaired physiological response, with a predominant focus on patients with heart failure. With stress echocardiography, we can measure the cardiovascular response during exercise in terms of cardiac function, valve function and haemodynamic function. Because of its comprehensive nature, the combinatorial approach of CPET imaging is not limited to the heart failure population but can be informative in other conditions, for example, valvular diseases, suspected or confirmed pulmonary hypertension and right heart phenotypes not detectable with rest evaluation.” Explaining their complementary properties, he continues, “CPET clarifies whether the impaired performance is central or peripherally limited and stress echocardiography allows us to verify whether there is a cardiac or haemodynamic reason for the exercise limitation.”
Prof. Guazzi describes how, “Combining CPET with stress echocardiography will have an impact especially when assessing patients, who combine a disease of the cardiac muscle, with, for example, mitral insufficiency. We previously investigated the functional and cardiac phenotypes of heart failure patients with reduced ejection fraction according to the degree of mitral regurgitation (MR) using CPET imaging and found that exercise-induced MR produces functional limitation similar to rest severe MR and that dynamic pulmonary hypertension with right ventricular uncoupling is a further limiting mechanism This haemodynamic pattern leads to remarkable exercise ventilation inefficiency and dyspnoea sensation.2”
Expert input will continue when our second host from Policlinico San Donato, Professor Francesco Bandera, demonstrates the value of combined CPET imaging with real-life clinical cases. The live case will exemplify the basis for measuring O2 consumption and gas exchange along with the haemodynamic pattern and valve disease assessment by stress echocardiography, primarily focusing on the mitral valve, its consequences on the pulmonary circulation and the right heart.
Prof. Guazzi and Prof. Bandera conclude, “CPET imaging is receiving expanding attention in the follow-up of many different cardiac patients, providing fundamental insights into the pathophysiology of exercise limitation and driving the clinical decision-making process. We do hope you will join us as we showcase the benefits it has to offer.”
1. Guazzi M, et al. J Am Coll Cardiol. 2017;70:1618-1636.
2. Bandera F, et al. Eur Heart J Cardiovasc Imaging. 2017;18:296-303.
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