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Heart failure and cardiomyopathies
Original research article
Repetitive squatting exercise as a diagnostic predictor in patients with dilated cardiomyopathy
  1. Krunoslav Michael Sveric,
  2. Stefan Ulbrich,
  3. Mohamed Rady,
  4. Christian Pflücke,
  5. Silvio Quick,
  6. Stefanie Katzke,
  7. Karim Ibrahim,
  8. Ruth H Strasser and
  9. Stefanie Jellinghaus
  1. Department for Internal Medicine and Cardiology, Herzzentrum Dresden, University Clinic, Technische Universität Dresden, Dresden, Germany
  1. Correspondence to Dr. Krunoslav Michael Sveric, Department of Cardiology, TU Dresden, Dresden 01307, Germany; kruno.sveric{at}caroconnect.de

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 χ2: 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.

  • cardiomyopathy dilated
  • three dimensional
  • stress

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2017-000733

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    Footnotes

    • KMS and SU contributed equally.

    • Contributors All authors have contributed to this investigation as follows: study concept and proposal (KMS and SU: both authors contributed equally), data acquisition (KMS, SU, MR, CP, SQ, SK, KI), data analysis (KMS, SU, MR), drafting of manuscript (KMS, SU,RHS, SJ) and critical revisions of the manuscript (all authors).

    • Funding This research received no grant from any funding agency in the public or commercial sectors.

    • Competing interests None declared.

    • Ethics approval Institutional Review Board of Techinical University Dresden, Medical Faculty.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.