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Published on: September 17, 2015
End-systolic elastance and ventricular-arterial coupling reserve predict cardiac events in patients with negative
Tonino Bombardini1, Marco Fabio Costantino, Rosa Sicari
1Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy.
Insights
Negative stress echocardiography can still indicate risk. Assessing left ventricular end-systolic elastance index (E(LV)I) reserve and ventricular arterial coupling (VAC) reserve during stress echo helps predict adverse cardiovascular events.
Area of Science:
- Cardiology
- Echocardiography
- Hemodynamics
Background:
- Maximal negative stress echocardiography identifies low-risk patients for coronary events.
- Prognostic value of cardiovascular hemodynamics for heart failure events in this group is unclear.
- This study investigates stress-induced hemodynamic variations in patients with negative stress echocardiography.
Purpose of the Study:
- To assess the prognostic value of stress-induced changes in cardiovascular hemodynamics.
- To identify predictors of death and heart failure hospitalization in patients with negative stress echocardiography.
Main Methods:
- 891 patients with negative stress echocardiography were enrolled.
- Left ventricular end-systolic elastance index (E(LV)I), ventricular arterial coupling (VAC), systemic vascular resistance (SVR), and pressure-volume area (PVA) were measured at rest and peak stress.
- Changes (reserve) were analyzed as predictors of combined death and heart failure hospitalization.
Main Results:
- During a median follow-up of 19 months, 50 deaths and 84 hospitalizations occurred.
- E(LV)I reserve was the best predictor for exercise and dobutamine stress echocardiography.
- VAC reserve was a significant predictor for dipyridamole stress echocardiography.
Conclusions:
- Patients with negative stress echocardiography can experience adverse outcomes.
- E(LV)I reserve and VAC reserve during stress echocardiography are valuable for identifying high-risk patients.
Background:
A maximal negative stress echo identifies a low-risk subset for coronary events. However, the potentially prognostically relevant information on cardiovascular hemodynamics for heart-failure-related events is unsettled. Aim of this study was to assess the prognostic value of stress-induced variation in cardiovascular hemodynamics in patients with negative stress echocardiography.
Methods:
We enrolled 891 patients (593 males mean age 63 ± 12, ejection fraction 48 ± 17%), with negative (exercise 172, dipyridamole 482, and dobutamine 237) stress echocardiography result. During stress we assessed left ventricular end-systolic elastance index (E(LV)I), ventricular arterial coupling (VAC) indexed by the ratio of the E(LV)I to arterial elastance index (E aI), systemic vascular resistance (SVR), and pressure-volume area (PVA). Changes from rest to peak stress (reserve) were tested as predictors of main outcome measures: combined death and heart failure hospitalization.
Results:
During a median followup of 19 months (interquartile range 8-36), 50 deaths and 84 hospitalization occurred. Receiver-operating-characteristic curves identified as best predictors E(LV)I reserve for exercise (AUC = 0.871) and dobutamine (AUC = 0.848) and VAC reserve (AUC = 0.696) for dipyridamole.
Conclusions:
Patients with negative stress echocardiography may experience an adverse outcome, which can be identified by assessment of E(LV)I reserve and VAC reserve during stress echo.
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