End-systolic pressure/volume relationship during dobutamine stress echo: a prognostically useful non-invasive index of left ventricular contractility.

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.

[1]  T. Bombardini.  Myocardial contractility in the echo lab: molecular, cellular and pathophysiological basis , 2005, Cardiovascular ultrasound.

[2]  J. Gardin,et al.  What parameters affect left ventricular diastolic flow propagation velocity? in vitro studies using color m-mode doppler echocardiography , 2005, Cardiovascular ultrasound.

[3]  E. Picano,et al.  Noninvasive assessment of left ventricular contractility by pacemaker stress echocardiography , 2005 .

[4]  Eugenio Picano,et al.  Usefulness of latent left ventricular dysfunction assessed by Bowditch Treppe to predict stress-induced pulmonary hypertension in minimally symptomatic severe mitral regurgitation secondary to mitral valve prolapse. , 2005, The American journal of cardiology.

[5]  R. Sicari.  Relevance of tissue Doppler in the quantification of stress echocardiography for the detection of myocardial ischemia in clinical practice , 2005, Cardiovascular ultrasound.

[6]  Lh Opie,et al.  Mechanisms of Cardiac Contraction and Relaxation , 2005 .

[7]  E. Agricola,et al.  Stress echocardiography in heart failure , 2004, Cardiovascular Ultrasound.

[8]  Eugenio Picano,et al.  Force-frequency relationship in the echocardiography laboratory: a noninvasive assessment of Bowditch treppe? , 2003, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[9]  H. Izawa,et al.  Impaired force-frequency relations in patients with hypertensive left ventricular hypertrophy. A possible physiological marker of the transition from physiological to pathological hypertrophy. , 1999, Circulation.

[10]  V. Bhargava,et al.  Loss of adrenergic control of the force-frequency relation in heart failure secondary to idiopathic or ischemic cardiomyopathy. , 1998, The American journal of cardiology.

[11]  L Crouse,et al.  Stress echocardiography: recommendations for performance and interpretation of stress echocardiography. Stress Echocardiography Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. , 1998, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[12]  H. Izawa,et al.  Adrenergic control of the force-frequency and relaxation-frequency relations in patients with hypertrophic cardiomyopathy. , 1997, Circulation.

[13]  S. Lemaire,et al.  High frequency-induced upregulation of human cardiac calcium currents. , 1996, Circulation.

[14]  J Ross,et al.  Adrenergic control of the force-frequency relation. , 1995, Circulation.

[15]  G. Hasenfuss,et al.  Influence of the force-frequency relationship on haemodynamics and left ventricular function in patients with non-failing hearts and in patients with dilated cardiomyopathy. , 1994, European heart journal.

[16]  N. Alpert,et al.  Myocardial Force‐Frequency Defect in Mitral Regurgitation Heart Failure Is Reversed by Forskolin , 1993, Circulation.

[17]  D. Kass,et al.  Diminished Contractile Response to Increased Heart Rate in Intact Human Left Ventricular Hypertrophy Systolic Versus Diastolic Determinants , 1993, Circulation.

[18]  N. Alpert,et al.  Altered Myocardial Force‐Frequency Relation in Human Heart Failure , 1992, Circulation.

[19]  F. Pashkow,et al.  Accuracy and limitations of exercise echocardiography in a routine clinical setting. , 1992, Journal of the American College of Cardiology.

[20]  N. Reichek,et al.  Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. , 1989, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[21]  M. Feldman,et al.  Depression of systolic and diastolic myocardial reserve during atrial pacing tachycardia in patients with dilated cardiomyopathy. , 1988, The Journal of clinical investigation.

[22]  M. Laks,et al.  Noninvasive measurement of the rest and exercise peak systolic pressure/end-systolic volume ratio: a sensitive two-dimensional echocardiographic indicator of left ventricular function. , 1984, Journal of the American College of Cardiology.

[23]  G. Schuler,et al.  Noninvasive assessment of myocardial contractility in asymptomatic patients with sever aortic regurgitation and normal left ventricular ejection fraction at rest. , 1982, The American journal of cardiology.