Pressure-volume relationship by pharmacological stress cardiovascular magnetic resonance.

Antonella Meloni,Francesco Grigioni,Chiara Cappelletto,Andrea Barison,Giancarlo Todiere,Michele Emdin,Valeria Calvi,Camilla Cavallaro,Giuseppina Novo,Cinzia Nugara,Maria Vaccaro,Antonio De Luca,Gianfranco Sinagra,Chrysanthos Grigoratos,Alessia Pepe

doi:10.1007/s10554-021-02464-0

Abstract

The variation between rest and peak stress end-systolic pressure-volume relation (ΔESPVR) is an index of myocardial contractility, easily obtained during routine stress echocardiography and never tested during dipyridamole stress-cardiac magnetic resonance (CMR). We assessed the ΔESPVR index in patients with known/suspected coronary artery disease (CAD) who underwent dipyridamole stress-CMR. One-hundred consecutive patients (24 females, 63.76 ± 10.17years) were considered. ESPVR index was evaluated at rest and stress from raw measurement of systolic arterial pressure and end-systolic volume by biplane Simpson's method. The ΔESPVR index showed a good inter-operator reproducibility. Mean ΔESPVR index was 0.48 ± 1.45mmHg/mL/m2. ΔESPVR index was significantly lower in males than in females. ΔESPVR index was not correlated to rest left ventricular end-diastolic volume index or ejection fraction. Forty-six of 85 patients had myocardial fibrosis detected by the late gadolinium enhancement technique and they showed significantly lower ΔESPVR values. An abnormal stress CMR was found in 25 patients and they showed significantly lower ΔESPVR values. During a mean follow-up of 56.34 ± 30.04months, 24 cardiovascular events occurred. At receiver-operating characteristic curve analysis, a ΔESPVR < 0.02mmHg/mL/m2 predicted the presence of future cardiac events with a sensitivity of 0.79 and a specificity of 0.68. The noninvasive assessment of the ΔESPVR index during a dipyridamole stress-CMR exam is feasible and reproducible. The ΔESPVR index was independent from rest LV dimensions and function and can be used for a comparative assessment of patients with different diseases. ΔESPVR indexby CMR can be a useful and simple marker for additional prognostic stratification.

Highlights

Cardiac contractility is the intrinsic capability of heart muscle to generate force and to shorten, ideally independently of changes in heart rate, preload or afterload
The ΔESPVR index was independent from rest left ventricular (LV) dimensions and function and can be used for a comparative assessment of patients with different diseases
The end-systolic pressure-volume ratio (ESPVR), defined as the ratio between the systolic pressure and the left ventricular (LV) end-systolic volume indexed for body surface area [2], assessed at rest and during stress, relies on the fact that a positive inotropic stimulation should be accompanied by higher end-systolic pressures with smaller endsystolic volumes

Summary

Introduction

Cardiac contractility is the intrinsic capability of heart muscle to generate force and to shorten, ideally independently of changes in heart rate, preload or afterload. The end-systolic pressure-volume ratio (ESPVR), defined as the ratio between the systolic pressure and the left ventricular (LV) end-systolic volume indexed for body surface area [2], assessed at rest and during stress, relies on the fact that a positive inotropic stimulation should be accompanied by higher end-systolic pressures with smaller endsystolic volumes. This index has become the most reliable noninvasive measure of contractility, being almost insensitive to changes in preload and afterload [3]. We assessed the ΔESPVR index in patients with known/suspected coronary artery disease (CAD) who underwent dipyridamole stress-CMR

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Discussion

Conclusion