Negative stress echo: Further prognostic stratification with assessment of pressure-volume relation

T. Bombardini, M. Galderisi, E. Agricola, V. Coppola, G. Mottola, E. Picano

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: A maximal negative stress echo identifies a low risk for subsequent hard events subset. However, the potentially prognostically relevant information on global contractile reserve on the left ventricle is missed by standard regional wall motion assessment, and can be obtained by end-systolic pressure-volume relationship (PVR) evaluation. Aim: To assess the relative prognostic value of PVR in patients with negative stress echo. Methods: We enrolled 99 consecutive patients (age = 61 ± 14 years; 81 males, LVEF 47 ± 14%, WMSI = 1.42 ± 0.50) with negative exercise stress echo for standard wall motion criteria. To build the PVR, the force was determined at rest and peak stress as the ratio of the systolic pressure/end-systolic volume index. All patients were followed-up on medical therapy. Results: Median follow-up was 21 months (interquartile range 12-26). Twenty-nine events have been observed: 6 deaths, 10 heart failure related hospitalization and 13 worsening NYHA class of ≥ 1 grade. Using Cox's proportional hazard model the best independent predictor of total events was SP/ESV index change (rest-stress) <1.5 mm Hg/ml/m2 as determined by ROC analysis cut-off (RR = 29, p = 0.001, sensitivity = 80%, specificity = 93%). The overall survival and event-free survival was 34% in patients with change (rest-stress) SP/ESV index <1.5 mm Hg/ml/m2 and 97% in whose with > 1.5 mm Hg/ml/m2. Conclusions: In patients with negative stress echo, a preserved global contractility response can be easily identified through stress-induced variation in SP/ESV index, with powerful further risk stratification.

Original languageEnglish
Pages (from-to)258-267
Number of pages10
JournalInternational Journal of Cardiology
Volume126
Issue number2
DOIs
Publication statusPublished - May 23 2008

Fingerprint

Pressure
Blood Pressure
Proportional Hazards Models
Heart Ventricles
Hospitalization
Heart Failure
Exercise
Therapeutics

Keywords

  • Contractile reserve
  • Pressure-volume relation
  • Prognosis
  • Stress echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Negative stress echo : Further prognostic stratification with assessment of pressure-volume relation. / Bombardini, T.; Galderisi, M.; Agricola, E.; Coppola, V.; Mottola, G.; Picano, E.

In: International Journal of Cardiology, Vol. 126, No. 2, 23.05.2008, p. 258-267.

Research output: Contribution to journalArticle

Bombardini, T. ; Galderisi, M. ; Agricola, E. ; Coppola, V. ; Mottola, G. ; Picano, E. / Negative stress echo : Further prognostic stratification with assessment of pressure-volume relation. In: International Journal of Cardiology. 2008 ; Vol. 126, No. 2. pp. 258-267.
@article{77f9aee732a74f6f9b63e646d1d6c9f5,
title = "Negative stress echo: Further prognostic stratification with assessment of pressure-volume relation",
abstract = "Background: A maximal negative stress echo identifies a low risk for subsequent hard events subset. However, the potentially prognostically relevant information on global contractile reserve on the left ventricle is missed by standard regional wall motion assessment, and can be obtained by end-systolic pressure-volume relationship (PVR) evaluation. Aim: To assess the relative prognostic value of PVR in patients with negative stress echo. Methods: We enrolled 99 consecutive patients (age = 61 ± 14 years; 81 males, LVEF 47 ± 14{\%}, WMSI = 1.42 ± 0.50) with negative exercise stress echo for standard wall motion criteria. To build the PVR, the force was determined at rest and peak stress as the ratio of the systolic pressure/end-systolic volume index. All patients were followed-up on medical therapy. Results: Median follow-up was 21 months (interquartile range 12-26). Twenty-nine events have been observed: 6 deaths, 10 heart failure related hospitalization and 13 worsening NYHA class of ≥ 1 grade. Using Cox's proportional hazard model the best independent predictor of total events was SP/ESV index change (rest-stress) <1.5 mm Hg/ml/m2 as determined by ROC analysis cut-off (RR = 29, p = 0.001, sensitivity = 80{\%}, specificity = 93{\%}). The overall survival and event-free survival was 34{\%} in patients with change (rest-stress) SP/ESV index <1.5 mm Hg/ml/m2 and 97{\%} in whose with > 1.5 mm Hg/ml/m2. Conclusions: In patients with negative stress echo, a preserved global contractility response can be easily identified through stress-induced variation in SP/ESV index, with powerful further risk stratification.",
keywords = "Contractile reserve, Pressure-volume relation, Prognosis, Stress echocardiography",
author = "T. Bombardini and M. Galderisi and E. Agricola and V. Coppola and G. Mottola and E. Picano",
year = "2008",
month = "5",
day = "23",
doi = "10.1016/j.ijcard.2006.12.093",
language = "English",
volume = "126",
pages = "258--267",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",
number = "2",

}

TY - JOUR

T1 - Negative stress echo

T2 - Further prognostic stratification with assessment of pressure-volume relation

AU - Bombardini, T.

AU - Galderisi, M.

AU - Agricola, E.

AU - Coppola, V.

AU - Mottola, G.

AU - Picano, E.

PY - 2008/5/23

Y1 - 2008/5/23

N2 - Background: A maximal negative stress echo identifies a low risk for subsequent hard events subset. However, the potentially prognostically relevant information on global contractile reserve on the left ventricle is missed by standard regional wall motion assessment, and can be obtained by end-systolic pressure-volume relationship (PVR) evaluation. Aim: To assess the relative prognostic value of PVR in patients with negative stress echo. Methods: We enrolled 99 consecutive patients (age = 61 ± 14 years; 81 males, LVEF 47 ± 14%, WMSI = 1.42 ± 0.50) with negative exercise stress echo for standard wall motion criteria. To build the PVR, the force was determined at rest and peak stress as the ratio of the systolic pressure/end-systolic volume index. All patients were followed-up on medical therapy. Results: Median follow-up was 21 months (interquartile range 12-26). Twenty-nine events have been observed: 6 deaths, 10 heart failure related hospitalization and 13 worsening NYHA class of ≥ 1 grade. Using Cox's proportional hazard model the best independent predictor of total events was SP/ESV index change (rest-stress) <1.5 mm Hg/ml/m2 as determined by ROC analysis cut-off (RR = 29, p = 0.001, sensitivity = 80%, specificity = 93%). The overall survival and event-free survival was 34% in patients with change (rest-stress) SP/ESV index <1.5 mm Hg/ml/m2 and 97% in whose with > 1.5 mm Hg/ml/m2. Conclusions: In patients with negative stress echo, a preserved global contractility response can be easily identified through stress-induced variation in SP/ESV index, with powerful further risk stratification.

AB - Background: A maximal negative stress echo identifies a low risk for subsequent hard events subset. However, the potentially prognostically relevant information on global contractile reserve on the left ventricle is missed by standard regional wall motion assessment, and can be obtained by end-systolic pressure-volume relationship (PVR) evaluation. Aim: To assess the relative prognostic value of PVR in patients with negative stress echo. Methods: We enrolled 99 consecutive patients (age = 61 ± 14 years; 81 males, LVEF 47 ± 14%, WMSI = 1.42 ± 0.50) with negative exercise stress echo for standard wall motion criteria. To build the PVR, the force was determined at rest and peak stress as the ratio of the systolic pressure/end-systolic volume index. All patients were followed-up on medical therapy. Results: Median follow-up was 21 months (interquartile range 12-26). Twenty-nine events have been observed: 6 deaths, 10 heart failure related hospitalization and 13 worsening NYHA class of ≥ 1 grade. Using Cox's proportional hazard model the best independent predictor of total events was SP/ESV index change (rest-stress) <1.5 mm Hg/ml/m2 as determined by ROC analysis cut-off (RR = 29, p = 0.001, sensitivity = 80%, specificity = 93%). The overall survival and event-free survival was 34% in patients with change (rest-stress) SP/ESV index <1.5 mm Hg/ml/m2 and 97% in whose with > 1.5 mm Hg/ml/m2. Conclusions: In patients with negative stress echo, a preserved global contractility response can be easily identified through stress-induced variation in SP/ESV index, with powerful further risk stratification.

KW - Contractile reserve

KW - Pressure-volume relation

KW - Prognosis

KW - Stress echocardiography

UR - http://www.scopus.com/inward/record.url?scp=42949115409&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=42949115409&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2006.12.093

DO - 10.1016/j.ijcard.2006.12.093

M3 - Article

C2 - 17509703

AN - SCOPUS:42949115409

VL - 126

SP - 258

EP - 267

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

IS - 2

ER -