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European Heart Journal Advance Access originally published online on August 16, 2005
European Heart Journal 2005 26(22):2404-2412; doi:10.1093/eurheartj/ehi444
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

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

Aurelia Grosu1, Tonino Bombardini2, Michele Senni1, Vincenzo Duino1, Mauro Gori1 and Eugenio Picano2,*

1Department of Cardiovascular Medicine and Internal Medicine, Ospedali Riuniti, Bergamo, Italy
2Department of Echocardiography, CNR, Institute of Clinical Physiology, Via Moruzzi 1, Pisa 56123, Italy

Received 23 February 2005; revised 21 June 2005; accepted 14 July 2005; online publish-ahead-of-print 16 August 2005.

* Corresponding author. Tel: +39 50 3152400; fax: +39 50 3152374. E-mail address: picano{at}ifc.cnr.it

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.

Key Words: Bowditch treppe • Force–frequency relationship • Dobutamine stress echocardiography • Heart failure


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