Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients–A Systematic Review and Meta-Analysis

Introduction: Exercise testing has become a diagnostic standard in the evaluation and management of heart disease. While different methods of exercise and pharmacological stress testing exist, only little is known about their comparability. We aimed to assess hemodynamic changes during dynamic exerc...

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Main Authors: Kilian Runte, Kay Brosien, Maximilian Salcher-Konrad, Charlotte Schubert, Leonid Goubergrits, Sebastian Kelle, Stephan Schubert, Felix Berger, Titus Kuehne, Marcus Kelm
Format: Article
Language:English
Published: Frontiers Media S.A. 2019-04-01
Series:Frontiers in Cardiovascular Medicine
Subjects:
Online Access:https://www.frontiersin.org/article/10.3389/fcvm.2019.00043/full
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author Kilian Runte
Kilian Runte
Kay Brosien
Maximilian Salcher-Konrad
Maximilian Salcher-Konrad
Charlotte Schubert
Charlotte Schubert
Leonid Goubergrits
Sebastian Kelle
Sebastian Kelle
Sebastian Kelle
Stephan Schubert
Stephan Schubert
Felix Berger
Felix Berger
Titus Kuehne
Titus Kuehne
Titus Kuehne
Marcus Kelm
Marcus Kelm
author_facet Kilian Runte
Kilian Runte
Kay Brosien
Maximilian Salcher-Konrad
Maximilian Salcher-Konrad
Charlotte Schubert
Charlotte Schubert
Leonid Goubergrits
Sebastian Kelle
Sebastian Kelle
Sebastian Kelle
Stephan Schubert
Stephan Schubert
Felix Berger
Felix Berger
Titus Kuehne
Titus Kuehne
Titus Kuehne
Marcus Kelm
Marcus Kelm
author_sort Kilian Runte
collection DOAJ
description Introduction: Exercise testing has become a diagnostic standard in the evaluation and management of heart disease. While different methods of exercise and pharmacological stress testing exist, only little is known about their comparability. We aimed to assess hemodynamic changes during dynamic exercise, isometric exercise, and dobutamine stress testing at different stress intensities in healthy subjects and patients with aortic stenosis (AS) and aortic coarctation (CoA).Methods: A systematic literature search (PROSPERO 2017:CRD42017078608) in MEDLINE of interventional trials was conducted to identify eligible studies providing evidence of changes in hemodynamic parameters under different stress conditions acquired by MRI or echocardiography. A random effects model was used to estimate pooled mean changes in hemodynamics.Results: One hundred and twenty-eight study arms with a total of 3,139 stress-examinations were included. In healthy subjects/(where available) in AS, pooled mean changes (95% CIs) during light dynamic stress were 31.78 (27.82–35.74) bpm in heart rate (HR) and 6.59 (2.58–10.61) ml in stroke volume (SV). Changes during light pharmacological stress were 13.71 (7.87–19.56)/14.0 (9.82–18.18) bpm in HR, and 5.47 (0.3–10.63)/8.0 (3.82–12.18) ml in SV. Changes during light isometric stress were 18.44 (10.74–26.14)/5.0 (−1.17–11.17) bpm in HR and −4.17 (−14.37–6.03)/−4.0 (−16.43–8.43) ml in SV. Changes during moderate dynamic stress were 49.57 (40.03–59.1)/46.45 (42.63–50.27) bpm in HR and 11.64 (5.87–17.42) ml in SV. During moderate pharmacological stress, changes in HR were 42.83 (36.94–48.72)/18.66 (2.38–34.93) bpm and in SV 6.29 (−2.0–14.58)/13.11 (7.99–18.23) ml. During high intensity dynamic stress changes in HR were 89.31 (81.46–97.17)/55.32 (47.31–63.33) bpm and in SV 21.31 (13.42–29.21)/−0.96 (−5.27–3.35) ml. During high pharmacological stress, changes in HR were 53.58 (36.53–70.64)/42.52 (32.77–52.28) bpm, and in SV 0.98 (−9.32–11.27)/14.06 (−1.62–29.74) ml. HR increase and age were inversely correlated at high stress intensities. In CoA, evidence was limited to single studies.Conclusion: This systematic review and meta-analysis presents pooled hemodynamic changes under light, moderate and high intensity exercise and pharmacological stress, while considering the potential influence of age. Despite limited availability of comparative studies, the reference values presented in this review allow estimation of the expected individual range of a circulatory response in healthy individuals and patients with AS and may contribute to future study planning and patient-specific models even when stress testing is contraindicated.
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spelling doaj.art-264af5a0cd5a45d29af9f49d795721e12022-12-22T02:00:14ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2019-04-01610.3389/fcvm.2019.00043436507Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients–A Systematic Review and Meta-AnalysisKilian Runte0Kilian Runte1Kay Brosien2Maximilian Salcher-Konrad3Maximilian Salcher-Konrad4Charlotte Schubert5Charlotte Schubert6Leonid Goubergrits7Sebastian Kelle8Sebastian Kelle9Sebastian Kelle10Stephan Schubert11Stephan Schubert12Felix Berger13Felix Berger14Titus Kuehne15Titus Kuehne16Titus Kuehne17Marcus Kelm18Marcus Kelm19Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité–Universitätsmedizin Berlin, Berlin, GermanyDepartment of Congenital Heart Disease, German Heart Center Berlin, Berlin, GermanyInstitute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité–Universitätsmedizin Berlin, Berlin, GermanyPersonal Social Services Research Unit, London School of Economics and Political Science, London, United KingdomLSE Health, London School of Economics and Political Science, London, United KingdomInstitute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité–Universitätsmedizin Berlin, Berlin, GermanyDepartment of Congenital Heart Disease, German Heart Center Berlin, Berlin, GermanyInstitute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité–Universitätsmedizin Berlin, Berlin, GermanyDepartment of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, GermanyDepartment of Internal Medicine/Cardiology, Charité–Universitätsmedizin Berlin, Berlin, GermanyGerman Center for Cardiovascular Research, Partner Site Berlin, Berlin, GermanyDepartment of Congenital Heart Disease, German Heart Center Berlin, Berlin, GermanyGerman Center for Cardiovascular Research, Partner Site Berlin, Berlin, GermanyDepartment of Congenital Heart Disease, German Heart Center Berlin, Berlin, GermanyGerman Center for Cardiovascular Research, Partner Site Berlin, Berlin, GermanyInstitute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité–Universitätsmedizin Berlin, Berlin, GermanyDepartment of Congenital Heart Disease, German Heart Center Berlin, Berlin, GermanyGerman Center for Cardiovascular Research, Partner Site Berlin, Berlin, GermanyInstitute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité–Universitätsmedizin Berlin, Berlin, GermanyDepartment of Congenital Heart Disease, German Heart Center Berlin, Berlin, GermanyIntroduction: Exercise testing has become a diagnostic standard in the evaluation and management of heart disease. While different methods of exercise and pharmacological stress testing exist, only little is known about their comparability. We aimed to assess hemodynamic changes during dynamic exercise, isometric exercise, and dobutamine stress testing at different stress intensities in healthy subjects and patients with aortic stenosis (AS) and aortic coarctation (CoA).Methods: A systematic literature search (PROSPERO 2017:CRD42017078608) in MEDLINE of interventional trials was conducted to identify eligible studies providing evidence of changes in hemodynamic parameters under different stress conditions acquired by MRI or echocardiography. A random effects model was used to estimate pooled mean changes in hemodynamics.Results: One hundred and twenty-eight study arms with a total of 3,139 stress-examinations were included. In healthy subjects/(where available) in AS, pooled mean changes (95% CIs) during light dynamic stress were 31.78 (27.82–35.74) bpm in heart rate (HR) and 6.59 (2.58–10.61) ml in stroke volume (SV). Changes during light pharmacological stress were 13.71 (7.87–19.56)/14.0 (9.82–18.18) bpm in HR, and 5.47 (0.3–10.63)/8.0 (3.82–12.18) ml in SV. Changes during light isometric stress were 18.44 (10.74–26.14)/5.0 (−1.17–11.17) bpm in HR and −4.17 (−14.37–6.03)/−4.0 (−16.43–8.43) ml in SV. Changes during moderate dynamic stress were 49.57 (40.03–59.1)/46.45 (42.63–50.27) bpm in HR and 11.64 (5.87–17.42) ml in SV. During moderate pharmacological stress, changes in HR were 42.83 (36.94–48.72)/18.66 (2.38–34.93) bpm and in SV 6.29 (−2.0–14.58)/13.11 (7.99–18.23) ml. During high intensity dynamic stress changes in HR were 89.31 (81.46–97.17)/55.32 (47.31–63.33) bpm and in SV 21.31 (13.42–29.21)/−0.96 (−5.27–3.35) ml. During high pharmacological stress, changes in HR were 53.58 (36.53–70.64)/42.52 (32.77–52.28) bpm, and in SV 0.98 (−9.32–11.27)/14.06 (−1.62–29.74) ml. HR increase and age were inversely correlated at high stress intensities. In CoA, evidence was limited to single studies.Conclusion: This systematic review and meta-analysis presents pooled hemodynamic changes under light, moderate and high intensity exercise and pharmacological stress, while considering the potential influence of age. Despite limited availability of comparative studies, the reference values presented in this review allow estimation of the expected individual range of a circulatory response in healthy individuals and patients with AS and may contribute to future study planning and patient-specific models even when stress testing is contraindicated.https://www.frontiersin.org/article/10.3389/fcvm.2019.00043/fullhemodynamicsexercise testingdobutamine stresshealthy subjectsaortic stenosisaortic coarctation
spellingShingle Kilian Runte
Kilian Runte
Kay Brosien
Maximilian Salcher-Konrad
Maximilian Salcher-Konrad
Charlotte Schubert
Charlotte Schubert
Leonid Goubergrits
Sebastian Kelle
Sebastian Kelle
Sebastian Kelle
Stephan Schubert
Stephan Schubert
Felix Berger
Felix Berger
Titus Kuehne
Titus Kuehne
Titus Kuehne
Marcus Kelm
Marcus Kelm
Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients–A Systematic Review and Meta-Analysis
Frontiers in Cardiovascular Medicine
hemodynamics
exercise testing
dobutamine stress
healthy subjects
aortic stenosis
aortic coarctation
title Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients–A Systematic Review and Meta-Analysis
title_full Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients–A Systematic Review and Meta-Analysis
title_fullStr Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients–A Systematic Review and Meta-Analysis
title_full_unstemmed Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients–A Systematic Review and Meta-Analysis
title_short Hemodynamic Changes During Physiological and Pharmacological Stress Testing in Healthy Subjects, Aortic Stenosis and Aortic Coarctation Patients–A Systematic Review and Meta-Analysis
title_sort hemodynamic changes during physiological and pharmacological stress testing in healthy subjects aortic stenosis and aortic coarctation patients a systematic review and meta analysis
topic hemodynamics
exercise testing
dobutamine stress
healthy subjects
aortic stenosis
aortic coarctation
url https://www.frontiersin.org/article/10.3389/fcvm.2019.00043/full
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