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 language | English |
|---|---|
| Pages (from-to) | 258-267 |
| Number of pages | 10 |
| Journal | International Journal of Cardiology |
| Volume | 126 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - May 23 2008 |
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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 journal › Article
}
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 -