Skip Navigation



European Heart Journal Advance Access published online on August 16, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi444
This Article
Right arrow Full Text (Rapid PDF)
Right arrow All Versions of this Article:
26/22/2404    most recent
ehi444v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Grosu, A.
Right arrow Articles by Picano, E.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Grosu, A.
Right arrow Articles by Picano, E.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received February 23, 2005
Revised June 21, 2005
Accepted July 14, 2005

Clinical research

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

Aurelia Grosu 1, Tonino Bombardini 2, Michele Senni 1, Vincenzo Duino 1, Mauro Gori 1, and Eugenio Picano 2*

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

* To whom correspondence should be addressed.
Eugenio Picano, E-mail: picano{at}ifc.cnr.it


  Abstract

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.

Keywords: Bowditch treppe; Force-frequency relationship; Dobutamine stress echocardiography; Heart failure.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 HeartHome page
L Cortigiani, T Bombardini, A Corbisiero, A Mazzoni, F Bovenzi, and E Picano
The additive prognostic value of end-systolic pressure-volume relation in patients with diabetes mellitus having negative dobutamine stress echocardiography by wall motion criteria
Heart, September 1, 2009; 95(17): 1429 - 1435.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.