Evidence map›Paper›PMID 36322266›Full record

ArticleThe international journal of cardiovascular imaging2022

Pulmonary congestion during Exercise stress Echocardiography in Hypertrophic Cardiomyopathy.

Eszter Dalma Pálinkás, Federica Re, Jesus Peteiro, Milorad Tesic, Attila Pálinkás, Marco Antonio Rodrigues Torres, Ana Djordjevic Dikic, Branko Beleslin, Caroline M Van De Heyning, Maria Grazia D'Alfonso and 10 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The international journal of cardiovascular imaging, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
2.3field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 15 citations in OpenAlex.

  1. Review
  2. Forward Dynamics: Modern Insights into Mitral Systolic Anterior Motion.Journal of cardiovascular development and disease · 2026
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

20 authors at 12 institutions in 8 countries.

Eszter Dalma PálinkásDoctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary.
Federica ReCardiology Department, San Camillo-Forlanini Hospital, Rome, Italy.
Jesus PeteiroCHUAC and University of A Coruña, CIBER-CV A Coruña, Spain.
Milorad TesicCardiology Clinic, Medical School, University Center Serbia, University of Belgrade, Belgrade, Serbia.
Attila PálinkásInternal Medicine Department, Elisabeth Hospital, Hódmezővásárhely, Hungary.
Marco Antonio Rodrigues TorresFederal University of Rio Grande do Sul, Porto Alegre, Brazil.
Ana Djordjevic DikicCardiology Clinic, Medical School, University Center Serbia, University of Belgrade, Belgrade, Serbia.
Branko BeleslinCardiology Clinic, Medical School, University Center Serbia, University of Belgrade, Belgrade, Serbia.
Caroline M Van De HeyningDepartment of Cardiology, Antwerp University Hospital, Edegem, Belgium.
Maria Grazia D'AlfonsoCardiovascular Imaging Division, Careggi University Hospital, Florence, Italy.
Fabio MoriCardiovascular Imaging Division, Careggi University Hospital, Florence, Italy.
Quirino CiampiFatebenefratelli Hospital, Benevento, Italy.
José Luis de Castro Silva PrettoHospital Sao Vicente de Paulo e Hospital de Cidade, Passo Fundo, Brazil.
Iana SimovaHeart and Brain Center of Excellence, University Hospital, Pleven, Bulgaria.
Viktória NagyDivision of Non-Invasive Cardiology, Department of Internal Medicine, Albert Szent- Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
Krisztina BodaDepartment of Medical Physics and Informatics, University of Szeged, Szeged, Hungary.
Róbert SeppDivision of Non-Invasive Cardiology, Department of Internal Medicine, Albert Szent- Györgyi Clinical Center, University of Szeged, Szeged, Hungary.
Iacopo OlivottoCardiomyopathy Unit, Careggi University Hospital, Florence, Italy.
Patricia A PellikkaDepartment of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Eugenio PicanoInstitute of Clinical Physiology, CNR, Pisa, Italy. picano@ifc.cnr.it.ORCID http://orcid.org/0000-0002-6375-6361
University of Szeged · HUAzienda Ospedaliero-Universitaria Careggi · ITUniversity of Belgrade · RSAntwerp University Hospital · BECarlo Forlanini Hospital · ITFatebenefratelli Hospital · ITHospital São Vicente de Paulo · BRIstituto di Fisiologia Clinica · ITMayo Clinic · USMedical University Pleven · BGUniversidade da Coruña · ESUniversidade Federal do Rio Grande do Sul · BR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundB-lines detected by lung ultrasound (LUS) during exercise stress echocardiography (ESE), indicating pulmonary congestion, have not been systematically evaluated in patients with hypertrophic cardiomyopathy (HCM).

aimTo assess the clinical, anatomical and functional correlates of pulmonary congestion elicited by exercise in HCM.

methodsWe enrolled 128 HCM patients (age 52 ± 15 years, 72 males) consecutively referred for ESE (treadmill in 46, bicycle in 82 patients) in 10 quality-controlled centers from 7 countries (Belgium, Brazil, Bulgaria, Hungary, Italy, Serbia, Spain). ESE assessment at rest and peak stress included: mitral regurgitation (MR, score from 0 to 3); E/e'; systolic pulmonary arterial pressure (SPAP) and end-diastolic volume (EDV). Change from rest to stress was calculated for each variable. Reduced preload reserve was defined by a decrease in EDV during exercise. B-lines at rest and at peak exercise were assessed by lung ultrasound with the 4-site simplified scan. B-lines positivity was considered if the sum of detected B-lines was ≥ 2.

resultsLUS was feasible in all subjects. B-lines were present in 13 patients at rest and in 38 during stress (10 vs 30%, p < 0.0001). When compared to patients without stress B-lines (n = 90), patients with B-lines (n = 38) had higher resting E/e' (14 ± 6 vs. 11 ± 4, p = 0.016) and SPAP (33 ± 10 vs. 27 ± 7 mm Hg p = 0.002). At peak exercise, patients with B-lines had higher peak E/e' (17 ± 6 vs. 13 ± 5 p = 0.003) and stress SPAP (55 ± 18 vs. 40 ± 12 mm Hg p < 0.0001), reduced preload reserve (68 vs. 30%, p = 0.001) and an increase in MR (42 vs. 17%, p = 0.013) compared to patients without congestion. Among baseline parameters, the number of B-lines and SPAP were the only independent predictors of exercise pulmonary congestion.

conclusionsTwo-thirds of HCM patients who develop pulmonary congestion on exercise had no evidence of B-lines at rest. Diastolic impairment and mitral regurgitation were key determinants of pulmonary congestion during ESE. These findings underscore the importance of evaluating hemodynamic stability by physiological stress in HCM, particularly in the presence of unexplained symptoms and functional limitation.

Indexed as

Cardiomyopathy, HypertrophicMitral Valve InsufficiencyPulmonary EdemaAdultAgedEchocardiography, DopplerEchocardiography, StressExercise TestHumansLungMaleMiddle AgedPredictive Value of TestsB-linesEchocardiographyExercise stress echocardiographyHypertrophic cardiomyopathyPulmonary congestion

Identifiers

PMID36322266
PMCPMC9708780
OpenAlexW4307976325

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.