A flat-biphasic end-systolic pressure-volume relationship during dobutamine stress echo strongly predicted cardiac events compared to an up-sloping pattern (RR 10.16, P<0.01).
Cohort (n=137)
Does the non-invasive estimation of left ventricular end-systolic pressure-volume relationship (PVR) during dobutamine stress echocardiography predict clinical events in patients referred for stress testing?
Non-invasive assessment of the end-systolic pressure-volume relationship during dobutamine stress echo is feasible, and a flat-biphasic contractility reserve pattern strongly predicts death and acute heart failure.
Effect estimate: RR 10.16
p-value: p=<0.01
AIMS: Left ventricular end-systolic pressure-volume relationship (PVR) provides a robust, relatively load-insensitive evaluation of contractility and can be assessed non-invasively during exercise echo. Dobutamine might provide an exercise-independent alternative approach to assess inotropic reserve. The feasibility of a non-invasive estimation of PVR during dobutamine stress in the echo lab and its relationship with subsequent clinical events was assessed. METHODS AND RESULTS: We enrolled 137 consecutive patients referred for dobutamine stress echo. To build the PVR, the force was determined at different heart rate increments during stepwise dobutamine infusion as the ratio of the systolic pressure/end-systolic volume index. The PVR at increasing heart rate was flat-biphasic in 65 and up-sloping in 72 patients: 42 patients underwent surgery and 95 patients were treated medically (median follow-up, 18 months; interquartile range, 12-24). Events occurred in 18 patients (death in eight, acute heart failure in 10); a flat-biphasic PVR was independent predictor of events (RR=10.16, P<0.01). CONCLUSION: PVR is feasible during dobutamine stress. This index of global contractility is reasonably simple, does not affect the imaging time, and only minimally prolongs the off-line analysis time. It allows unmasking quite different, and heterogeneous, contractility reserve patterns underlying a given ejection fraction at rest. The best survival is observed in patients with up-sloping PVR, whereas flat-biphasic pattern is a strong predictor of cardiac events.
Grosu et al. (Tue,) conducted a cohort in Patients referred for dobutamine stress echocardiography (n=137). End-systolic pressure-volume relationship (PVR) assessment during dobutamine stress echo vs. Up-sloping PVR vs flat-biphasic PVR was evaluated on Clinical events (death or acute heart failure) (RR 10.16, p=<0.01). A flat-biphasic end-systolic pressure-volume relationship during dobutamine stress echo strongly predicted cardiac events compared to an up-sloping pattern (RR 10.16, P<0.01).