Bombardini, Tonino (6701802597)Tonino (6701802597)BombardiniZagatina, Angela (22939399700)Angela (22939399700)ZagatinaCiampi, Quirino (6602299243)Quirino (6602299243)CiampiArbucci, Rosina (57201675703)Rosina (57201675703)ArbucciMerlo, Pablo Martin (57191339958)Pablo Martin (57191339958)MerloLowenstein Haber, Diego M. (56112672500)Diego M. (56112672500)Lowenstein HaberMorrone, Doralisa (36478990700)Doralisa (36478990700)MorroneD’andrea, Antonello (55612687400)Antonello (55612687400)D’andreaDjordjevic-Dikic, Ana (57003143600)Ana (57003143600)Djordjevic-DikicBeleslin, Branko (6701355424)Branko (6701355424)BeleslinTesic, Milorad (36197477200)Milorad (36197477200)TesicBoskovic, Nikola (6508290354)Nikola (6508290354)BoskovicGiga, Vojislav (55924460200)Vojislav (55924460200)Gigade Castro e Silva Pretto, José Luis (6508318426)José Luis (6508318426)de Castro e Silva PrettoDaros, Clarissa Borguezan (57192979152)Clarissa Borguezan (57192979152)DarosAmor, Miguel (37066931100)Miguel (37066931100)AmorMosto, Hugo (23485887100)Hugo (23485887100)MostoSalamè, Michael (57235732400)Michael (57235732400)SalamèMonte, Ines (55884115100)Ines (55884115100)MonteCitro, Rodolfo (15921921800)Rodolfo (15921921800)CitroSimova, Iana (23391267500)Iana (23391267500)SimovaSamardjieva, Martina (57237410300)Martina (57237410300)SamardjievaWierzbowska-Drabik, Karina (12772110800)Karina (12772110800)Wierzbowska-DrabikKasprzak, Jaroslaw D. (35452933600)Jaroslaw D. (35452933600)KasprzakGaibazzi, Nicola (6603190525)Nicola (6603190525)GaibazziCortigiani, Lauro (55663049600)Lauro (55663049600)CortigianiScali, Maria Chiara (55929478400)Maria Chiara (55929478400)ScaliPepi, Mauro (7006081973)Mauro (7006081973)PepiAntonini-Canterin, Francesco (36811810300)Francesco (36811810300)Antonini-CanterinTorres, Marco A. R. (7402581476)Marco A. R. (7402581476)TorresDe Nes, Michele (6507042094)Michele (6507042094)De NesOstojic, Miodrag (34572650500)Miodrag (34572650500)OstojicCarpeggiani, Clara (7003751506)Clara (7003751506)CarpeggianiKovačević-Preradović, Tamara (21743080300)Tamara (21743080300)Kovačević-PreradovićLowenstein, Jorge (7103408229)Jorge (7103408229)LowensteinArruda-Olson, Adelaide M. (6506472111)Adelaide M. (6506472111)Arruda-OlsonPellikka, Patricia A. (7007042258)Patricia A. (7007042258)PellikkaPicano, Eugenio (7102408994)Eugenio (7102408994)Picano2025-06-122025-06-122021https://doi.org/10.3390/jcm10132906https://www.scopus.com/inward/record.uri?eid=2-s2.0-85113730109&doi=10.3390%2fjcm10132906&partnerID=40&md5=20931989d7b09010edee7e5fd2de9695https://remedy.med.bg.ac.rs/handle/123456789/4133Background: Two-dimensional volumetric exercise stress echocardiography (ESE) provides an integrated view of left ventricular (LV) preload reserve through end-diastolic volume (EDV) and LV contractile reserve (LVCR) through end-systolic volume (ESV) changes. Purpose: To assess the dependence of cardiac reserve upon LVCR, EDV, and heart rate (HR) during ESE. Methods: We prospectively performed semi-supine bicycle or treadmill ESE in 1344 patients (age 59.8 ± 11.4 years; ejection fraction = 63 ± 8%) referred for known or suspected coronary artery disease. All patients had negative ESE by wall motion criteria. EDV and ESV were measured by biplane Simpson rule with 2-dimensional echocardiography. Cardiac index reserve was identified by peak-rest value. LVCR was the stress-rest ratio of force (systolic blood pressure by cuff sphygmomanometer/ESV, abnormal values ≤2.0). Preload reserve was defined by an increase in EDV. Cardiac index was calculated as stroke volume index * HR (by EKG). HR reserve (stress/rest ratio) <1.85 identified chronotropic incompetence. Results: Of the 1344 patients, 448 were in the lowest tertile of cardiac index reserve with stress. Of them, 303 (67.6%) achieved HR reserve <1.85; 252 (56.3%) had an abnormal LVCR and 341 (76.1%) a reduction of preload reserve, with 446 patients (99.6%) showing ≥1 abnormality. At binary logistic regression analysis, reduced preload reserve (odds ratio [OR]: 5.610; 95% confidence intervals [CI]: 4.025 to 7.821), chronotropic incompetence (OR: 3.923, 95% CI: 2.915 to 5.279), and abnormal LVCR (OR: 1.579; 95% CI: 1.105 to 2.259) were independently associated with lowest tertile of cardiac index reserve at peak stress. Conclusions: Heart rate assessment and volumetric echocardiography during ESE identify the heterogeneity of hemodynamic phenotypes of impaired chronotropic, preload or LVCR underlying a reduced cardiac reserve. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.Cardiac reserveEnd-diastolic volumeEnd-systolic volumeHeart rateStress echocardiography