Repetitive squatting exercise as a diagnostic predictor in patients with dilated cardiomyopathy. Issue 1 (17th February 2018)

• Record Type: Journal Article
• Authors: Sveric, Krunoslav Michael; Ulbrich, Stefan; Rady, Mohamed; Pflücke, Christian; Quick, Silvio; Katzke, Stefanie; Ibrahim, Karim; Strasser, Ruth H; Jellinghaus, Stefanie
• Is Part Of: Open heart. Volume 5:Issue 1(2018)
• Publication Date: 2018-02-17
• Subjects: cardiomyopathy dilated -- three dimensional -- stress; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Patients -- Periodicals; 616.12005
• DOI: 10.1136/openhrt-2017-000733
• Languages: English
• ISSNs: 2398-595X

Abstract

Abstract : Objectives: Non-ischaemic dilated cardiomyopathy (DCM) is characterised by a highly variable disease progression. Stress echocardiography and cardiopulmonary exercise testing (CPET) are beneficial in risk assessment, but are labour intensive. Repetitive squatting and standing without weights is a simple exercise (EX). The aim of this study was to investigate the prognostic role of left ventricular (LV) contractile recruitment (CR) after a simple EX of repetitive squatting through three-dimensional (3D) echocardiography. Methods: Patients with DCM (LV ejection fraction (EF)<50%, n=68) and age-matched healthy volunteers (n=25) received a 3D echocardiographic evaluation of LV EF before and after 30 repetitions of squatting-standing EX. CR was defined by the change of LV EF (Δ>4%). Patients were followed up prospectively (2 years) for cardiac death and deteriorating heart failure. Results: During follow-up, 14 cardiac events occurred (21%) with six deaths and eight severe heart failure deteriorations. A poor CR after squatting EX differentiated DCM patients with cardiac events during follow-up as accurately as a reduced peak oxygen consumption (peak VO 2 <20 mL/kg/min) (sensitivity: 0.97 and 0.95). Both had a significant incremental diagnostic value over clinical (age, dyspnoea and natriuretic peptide level) or resting echocardiographic parameters (E/E' ratio, LV EF and end-diastolic LV volume) to predict cardiac events (global χ 2 : 16.0 vs 5.3; 19.5 vs 6.1; P<0.01 for all). Conclusions: The presence of LV CR after EX of repetitive squatting without weights can stratify risk and predict cardiac events in patients with DCM as correct as CPET.