The prognostic value of stroke work/end-diastolic volume ratio during stress echocardiography
Tonino Bombardini1, Lauro Cortigiani2, Quirino Ciampi3
1Faculty of Medicine, Clinical Center of The Republic of Srpska, University of Banja-Luka, Banja-Luka, Bosnia-Herzegovina.
Insights
The simpler non-invasive stroke work to end-diastolic volume ratio (SW/EDV) effectively predicts patient outcomes, comparable to the more complex single-beat preload-recruitable stroke work (SBPRSW) method in stress-echo labs.
Area of Science:
- Cardiology
- Echocardiography
- Hemodynamics
Background:
- Ventricular stroke work (SW) measures the left ventricle's pumping efficiency per cardiac cycle.
- Preload-recruitable stroke work (PRSW) links SW to end-diastolic volume (EDV).
- Non-invasive single-beat PRSW (SBPRSW) requires complex calculations and software.
Purpose of the Study:
- To compare the prognostic power of non-invasive SBPRSW with the simpler non-invasive SW/EDV ratio.
- To evaluate these methods in a stress-echo laboratory setting.
Main Methods:
- 692 patients with negative stress echo underwent SBPRSW and SW/EDV measurements at rest and peak stress.
- Patients were followed for major adverse events.
- Kaplan-Meier curves and ROC analysis were used for prognostic evaluation.
Main Results:
- SBPRSW and SW/EDV showed strong linear correlations at rest and peak stress (r > 0.84).
- Both methods demonstrated significant prognostic power (p < .001).
- The simpler SW/EDV ratio showed non-inferior survival prediction compared to SBPRSW.
Conclusions:
- Non-invasive SBPRSW and SW/EDV measurements are highly comparable.
- Both SBPRSW and SW/EDV are effective in predicting patient follow-up events.
- The SW/EDV ratio offers a simpler, effective alternative for prognostic assessment in stress-echo labs.
Background:
The ventricular stroke work (SW) refers to the work done by the left ventricle to eject the volume of blood during one cardiac cycle. The cath-lab relationship between SW and end-diastolic volume (EDV) is the preload-recruitable SW (PRSW). Recently a non-invasive single-beat PRSW (SBPRSW) has been proposed. However, the single beat formula needs mathematical skillness, and extra software. Aim of this study was to compare the non-invasive SBPRSW with the simpler non-invasive SW/EDVratio in the stress-echo lab.
Methods:
We studied 692 patients, age 62 ± 12 years, ejection fraction 50 ± 17%, with negative stress echo (SE)(exercise, n = 130, dobutamine, n = 124, dipyridamole, n = 438) and follow-up data. The PRSW was estimated at rest and at peak stress by the SBPRSW technique and compared with the SW/EDV. All patients were followed-up. Event rates were estimated with Kaplan-Meier curves.
Results:
SBPRSW and SW/EDV were linearly correlated at rest (r = 0.842, p < .001) and at peak stress (r = 0.860, p < .001). During a median follow-up of 20 months (first quartile 8, third quartile 40 months), 132 major events were registered: at receiver operating characteristic (ROC) analysis rest SBPRSW vs. SW/EDV (AUC 0.691 vs. 0.722) and peak stress (AUC 0.744 vs. 0.800) demonstrated both a significant prognostic power (all p < .001) with non-inferior survival prediction of the simpler SW/EDV ratio at Kaplan-Meier curves (Chi-square rest = 38, peak = 56) vs. SBPRSW (Chi-square rest = 14, peak = 42).
Conclusions:
The data obtained with the non-invasive SBPRSW and by the simpler SW/EDV are highly comparable. PRSW with either SB or SW/EDV approach is effective in predicting follow-up events.
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