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See detailExercise and pharmacological stress echocardiography in healthy horses
Sandersen, Charlotte ULg; Detilleux, Johann ULg; Art, Tatiana ULg et al

in Equine Veterinary Journal. Supplement (2006), 37

REASONS FOR PERFORMING STUDY: Stress echocardiography could be a useful diagnostic test in horses suspected to suffer from exercise-induced myocardial dysfunction as a cause of exercise intolerance ... [more ▼]

REASONS FOR PERFORMING STUDY: Stress echocardiography could be a useful diagnostic test in horses suspected to suffer from exercise-induced myocardial dysfunction as a cause of exercise intolerance. OBJECTIVE: To evaluate the effect of treadmill exercise and pharmacological stress test on left ventricular echocardiographic parameters. METHODS: Echocardiography was performed in 2 groups of 5 healthy horses, either immediately after a near-maximal treadmill exercise (Group EXE) or during a pharmacological challenge (Group DOB) consisting of 35 microg/kg atropine, followed by incremental dobutamine infusion rates of 2-6 microg/kg bwt/min for 5 min duration each, which led to a cumulative dobutamine dose of 100 microg/kg. Left ventricular M-mode parameters were compared at rest and at heart rates of 80, 100, 110, 120 130, and 140 beats/min, within each group. RESULTS: In 2 horses of Group EXE, echocardiographic measurements were impossible at 140 and 130 beats/min, as their heart rates dropped too fast in the immediate post exercise period. In the remaining 3 horses image quality was not always satisfactory at heart rates of 130 and 140 beats/min. Systolic left ventricular parameters and fractional shortening measured at 130 and 140 beats/min were significantly different from values obtained at lower heart rates. Horses in Group DOB reached expected heart rates of 80 and 100 beats/min, after the administration of atropine and during a dobutamine infusion rate of 2 microg/kg bwt/min, respectively. Heart rates targets of 110, 120, 130, and 140 beats/min were reached at mean (+/- s.d.) dobutamine infusion rates of 2.8 +/- 0.4, 3.2 +/- 0.4, 4.0 +/- 0.7, 5 +/- 0.7 microg/kg bwt/min, respectively. Systolic left ventricular parameters and fractional shortening at heart rates of 110, 120, 130, and 140 beats/min, were significantly different from values obtained at lower heart rates. CONCLUSION: The pharmacological stress test induced changes in ventricular dimensions at heart rates of 80 to 140 beats/min. Using this test, high quality images can easily be obtained at heart rates of 140 beats/min. Conversely, in post exercise echocardiography, obtaining good quality images at heart rates of 130 and 140 beats/min is difficult, which limits use of the technique in routine clinical settings. POTENTIAL RELEVANCE: Further studies should demonstrate the potential of pharmacological stress test as a diagnostic tool in horses suffering from exercise-induced myocardial dysfunction. [less ▲]

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See detailExercise Echocardiography in Asymptomatic Patients with Severe Aortic Stenosis and Preserved Left Ventricular Ejection Fraction.
Henri, Christine; Lancellotti, Patrizio ULg

in Journal of cardiovascular ultrasound (2014), 22(1), 1-5

The management of asymptomatic patients with severe aortic stenosis (AS) remains controversial. Recent series reported that early aortic valve replacement might be associated with improved clinical ... [more ▼]

The management of asymptomatic patients with severe aortic stenosis (AS) remains controversial. Recent series reported that early aortic valve replacement might be associated with improved clinical outcomes. However, the risk-benefit ratio should be carefully evaluated and early surgery only be proposed to a subset of asymptomatic patients considered at higher risk. Exercise echocardiography can help unmask symptomatic patients combined with assessment of the hemodynamic consequences of AS. Recent studies have demonstrated that exercise echocardiography can provide incremental prognostic value to identify patients who may benefit most from early surgery. In "truly" asymptomatic patients, an increase in mean aortic gradient >/= 18-20 mmHg, a limited left ventricular contractile reserve or a pulmonary hypertension during exercise are predictive parameters of adverse cardiac events. Exercise echocardiography is low-cost, safe and available in many referral centers, and does not expose patients to radiation. The purpose of this article is to describe the role of exercise testing and echocardiography in the management of asymptomatic patients with severe AS and preserved left ventricular ejection fraction. [less ▲]

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See detailExercise echocardiography in severe asymptomatic aortic stenosis.
O'Connor, K.; LANCELLOTTI, Patrizio ULg; Donal, E. et al

in Archives of Cardiovascular Diseases (2010), 103(4), 262-269

The management of asymptomatic patients with severe aortic stenosis is challenging. Unfortunately, evaluation of symptoms such as dyspnoea remains subjective. The use of exercise echocardiography may help ... [more ▼]

The management of asymptomatic patients with severe aortic stenosis is challenging. Unfortunately, evaluation of symptoms such as dyspnoea remains subjective. The use of exercise echocardiography may help to predict major events in patients with asymptomatic severe aortic stenosis. This article explains how to perform the test and discusses which echocardiographic measurements should be obtained, focusing on the diagnostic and prognostic value of these measurements. An increase in mean transaortic pressure gradient >or= 18 mmHg predicts a worse prognosis in patients with severe aortic stenosis. The absence of left ventricular contractile reserve also has an important prognostic impact. Evaluation of filling pressures and looking for a worsening or a new mitral regurgitation are also part of the exam. Further studies are required to determine whether surgery should be recommended in the presence of an abnormal exercise echocardiogram in severe asymptomatic aortic stenosis. [less ▲]

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See detailExercise in the Management of Non-Insulin-Dependent (Type 2) Diabetes Mellitus
Gautier, J. F.; Scheen, André ULg; Lefebvre, P. J.

in International Journal of Obesity & Related Metabolic Disorders (1995), 19(Suppl 4), 58-61

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See detailExercise intervention prevents falls in frail older patients
Bruyère, Olivier ULg

E-print/Working paper (2007)

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See detailExercise modifies the innate immune response in equine bronchial epithelial cells
Frellstedt, Linda ULg; Gosset, Philippe; Pirottin, Dimitri ULg et al

in Proceedings of the 3rd Scientific Meeting of the Faculty of Veterinary Medicine (University of Liege - Belgium) (2013)

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See detailExercise physiology in jumping horses
Art, Tatiana ULg; Amory, Hélène ULg; Desmecht, Daniel ULg et al

in Archives Internationales de Physiologie et de Biochimie (1991)

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See detailExercise pulmonary hypertension in asymptomatic degenerative mitral regurgitation
Magne, Julien ULg; Lancellotti, Patrizio ULg; Pierard, Luc ULg

in Circulation (2010), 122(1), 33-41

BACKGROUND: Current guidelines recommend mitral valve surgery for asymptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular systolic function when exercise ... [more ▼]

BACKGROUND: Current guidelines recommend mitral valve surgery for asymptomatic patients with severe degenerative mitral regurgitation and preserved left ventricular systolic function when exercise pulmonary hypertension (PHT) is present. However, the determinants of exercise PHT have not been evaluated. The aim of this study was to identify the echocardiographic predictors of exercise PHT and the impact on symptoms. <br /> <br />METHODS AND RESULTS: Comprehensive resting and exercise transthoracic echocardiography was performed in 78 consecutive patients (age, 61+/-13 years; 56% men) with at least moderate degenerative mitral regurgitation (effective regurgitant orifice area =43+/-20 mm(2); regurgitant volume =71+/-27 mL). Exercise PHT was defined as a systolic pulmonary arterial pressure (SPAP) >60 mm Hg. Exercise PHT was present in 46% patients. In multivariable analysis, exercise effective regurgitant orifice was an independent determinant of exercise SPAP (P<0.0001) and exercise PHT (P=0.002). Resting PHT and exercise PHT were associated with markedly reduced 2-year symptom-free survival (36+/-14% versus 59+/-7%, P=0.04; 35+/-8% versus 75+/-7%, P<0.0001). After adjustment, although the impact of resting PHT was no longer significant, exercise PHT was identified as an independent predictor of the occurrence of symptoms (hazard ratio=3.4; P=0.002). Receiver-operating characteristics curves revealed that exercise PHT (SPAP >56 mm Hg) was more accurate than resting PHT (SPAP >36 mm Hg) in predicting the occurrence of symptoms during follow-up (P=0.032). <br /> <br />CONCLUSIONS: Exercise PHT is frequent in patients with asymptomatic degenerative mitral regurgitation. Exercise mitral regurgitation severity is a strong independent predictor of both exercise SPAP and exercise PHT. Exercise PHT is associated with markedly low 2-year symptom-free survival, emphasizing the use of exercise echocardiography. An exercise SPAP >56 mm Hg accurately predicts the occurrence of symptoms. [less ▲]

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See detailExercise Pulmonary Hypertension in Asymptomatic Severe Aortic Stenosis.
Magne, Julien ULg; Donal, E; O'Connor, K et al

Conference (2011)

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See detailExercise stress echocardiography in healthy horses
Amory, Hélène ULg; Brihoum, M; Debrue, M et al

in Proceedings of the 41st Annual Congress of the British Equine Veterinary Association (BEVA) (2002)

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See detailExercise Testing and Stress Imaging in Valvular Heart Disease.
henri, Christine; Pierard, Luc ULg; Lancellotti, Patrizio ULg et al

in The Canadian journal of cardiology (2014), 30(9), 1012-1026

The role of exercise testing and stress imaging in the management of patients with valvular heart disease (VHD) is reviewed in this article. The American College of Cardiology/American Heart Association ... [more ▼]

The role of exercise testing and stress imaging in the management of patients with valvular heart disease (VHD) is reviewed in this article. The American College of Cardiology/American Heart Association and the European Society of Cardiology/European Association of Cardiothoracic Surgery have recently put emphasis on the role of exercise testing to clarify symptom status and the use of stress imaging to assess the dynamic component of valvular abnormalities and unmask subclinical myocardial dysfunction that could be missed at rest. Recent studies have demonstrated the incremental prognostic value of exercise echocardiography for asymptomatic patients with severe aortic stenosis, moderate-severe mitral stenosis, and severe primary mitral regurgitation. In patients with low-flow, low-gradient aortic stenosis, dobutamine stress echocardiography is recommended to differentiate true severe from pseudosevere aortic stenosis. Data on the prognostic value of stress echocardiography in aortic regurgitation and functional mitral regurgitation are less robust. Data are sparse on the use of stress imaging in right-sided VHD, however recent studies using stress cardiovascular magnetic resonance imaging offer some prognostic information. Although the strongest recommendations for surgical treatment continue to be based on symptom status and resting left ventricular repercussions, stress imaging can be useful to optimize risk stratification and timing of surgery in VHD. Randomized clinical trials are required to confirm that clinical decision-making based on stress imaging can lead to improved outcomes. [less ▲]

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See detailExercise testing in aortic stenosis and in mitral regurgitation
LANCELLOTTI, Patrizio ULg; Magne, Julien ULg

in Cardiac valvular medicine (2012)

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See detailExercise testing in asymptomatic severe aortic stenosis.
Magne, Julien ULg; Lancellotti, Patrizio ULg; Pierard, Luc ULg

in JACC. Cardiovascular imaging (2014), 7(2), 188-99

The management and the clinical decision making in asymptomatic patients with aortic stenosis are challenging. An "aggressive" management, including early aortic valve replacement, is debated in these ... [more ▼]

The management and the clinical decision making in asymptomatic patients with aortic stenosis are challenging. An "aggressive" management, including early aortic valve replacement, is debated in these patients. However, the optimal timing for surgery remains controversial due to the lack of prospective data on the determinants of aortic stenosis progression, multicenter studies on risk stratification, and randomized studies on patient management. Exercise stress testing with or without imaging is strictly contraindicated in symptomatic patients with severe aortic stenosis. Exercise stress test is now recommended by current guidelines in asymptomatic patients and may provide incremental prognostic value. Indeed, the development of symptoms during exercise or an abnormal blood pressure response are associated with poor outcome and should be considered as an indication for surgery, as suggested by the most recently updated European Society of Cardiology 2012 guidelines. Exercise stress echocardiography may also improve the risk stratification and identify asymptomatic patients at higher risk of a cardiac event. When the test is combined with imaging, echocardiography during exercise should be recommended rather than post-exercise echocardiography. During exercise, an increase >18 to 20 mm Hg in mean pressure gradient, absence of improvement in left ventricular ejection fraction (i.e., absence of contractile reserve), and/or a systolic pulmonary arterial pressure >60 mm Hg (i.e., exercise pulmonary hypertension) are suggestive signs of advanced stages of the disease and impaired prognosis. Hence, exercise stress test may identify resting asymptomatic patients who develop exercise abnormalities and in whom surgery is recommended according to current guidelines. Exercise stress echocardiography may further unmask a subset of asymptomatic patients (i.e., without exercise stress test abnormalities) who are at high risk of reduced cardiac event free survival. In these patients, early surgery could be beneficial, whereas regular follow-up seems more appropriate in patients without echocardiographic abnormalities during exercise. [less ▲]

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See detailExercise ventilation inefficiency in heart failure: pathophysiological and clinical significance
Tumminello, G.; Guazzi, M.; LANCELLOTTI, Patrizio ULg et al

in European Heart Journal (2007), 28(6), 673-678

Heart failure (HF) is a complex syndrome characterized by myocardial dysfunction and a poor prognosis. Among multiple markers of severity, an exercise ventilation inefficiency has important clinical and ... [more ▼]

Heart failure (HF) is a complex syndrome characterized by myocardial dysfunction and a poor prognosis. Among multiple markers of severity, an exercise ventilation inefficiency has important clinical and prognostic value. The pathophysiology determining exercise ventilatory inefficiency is complex and not definitively clarified. Three different mechanisms have been identified: (i) increased dead space, (ii) early occurrence of lactic acidosis, and (iii) abnormal chemoreflex and/or metaboreflex activity. Besides its prognostic value, abnormal ventilation can be influenced by pharmacological and non-pharmacological therapies such as beta-blockers, selective cyclic 3'-5' guanosine monosphosphate phosphodiesterase inhibitors, physical training, and nocturnal continuous positive airway pressure. There is an increasing interest for the exercise periodic breathing, which is frequently associated with HF syndrome and has prognostic importance. The precise mechanisms sustaining exercise periodic breathing are not fully defined but ventilatory and metabo-haemodynamic hypotheses have been proposed. [less ▲]

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See detailExercise Versus Dobutamine-Induced St Elevation in the Infarct-Related Electrocardiographic Leads: Clinical Significance and Correlation with Functional Recovery
Lancellotti, Patrizio ULg; Seidel, Laurence ULg; Hoffer, E. et al

in American Heart Journal (2001), 141(5), 772-9

BACKGROUND: The clinical significance of stress-induced ST elevation early after acute myocardial infarction and its relation to functional recovery remain controversial. The aims of this study were (1 ... [more ▼]

BACKGROUND: The clinical significance of stress-induced ST elevation early after acute myocardial infarction and its relation to functional recovery remain controversial. The aims of this study were (1) to determine the incidence of ST elevation during dobutamine and exercise tests and (2) to assess the relative accuracy of exercise and dobutamine ST elevation for predicting functional recovery after acute myocardial infarction. METHODS AND RESULTS: We investigated 52 patients who underwent supine exercise (from 25 W to maximal charge) and dobutamine (from 5 to 40 microg/kg per minute and up to 1 mg atropine) stress electrocardiography in the same position. ST elevation was defined as new or worsening at >1 mm, 80 ms after J point. Echocardiography and quantitative angiography were available in all patients before hospital discharge. The follow-up resting echocardiogram was recorded 30 +/- 6 days after the acute event. ST elevation developed during 30 (58%) dobutamine and 24 (46%) exercise tests. The sum of ST elevation was higher during dobutamine testing (7.7 +/- 3.8 mm) than during exercise (5.5 +/- 2.5 mm) (P =.03). A low peak creatine kinase level was the single independent predictor of dobutamine-induced ST elevation. Functional improvement occurred in 35 patients. Two independent predictors of functional recovery were selected from multivariate analysis: dobutamine ST elevation (chi(2) = 9.1; P =.0026) and low peak creatine kinase level (chi(2) = 5.1; P =.025). When dobutamine ST elevation was not included in multivariate analysis, exercise-induced ST elevation emerged as an independent predictor of functional recovery (chi(2) = 5.0; P =.023). Significant linear correlation was found between the sum of ST elevation at peak dobutamine stress and the extent of functional recovery (r = 0.87; P <.0001). In contrast, no correlation was observed with exercise ST elevation (r = 0.06; P = not significant). CONCLUSIONS: Stress-induced ST elevation is an ancillary sign of viable myocardium that can recover. The sum of ST elevation at peak dobutamine stress correlates with the extent of functional recovery. [less ▲]

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