The additive prognostic value of end-systolic pressure-volume relation by stress CMR in patients with known or suspected coronary artery disease

Abstract

PurposeThe difference between rest and peak stress end-systolic pressure-volume relation (Delta ESPVR) is an afterload-independent index of left ventricular (LV) contractility. We assessed the independent prognostic value of Delta ESPVR index by dipyridamole stress-cardiovascular magnetic resonance (CMR) in patients with known/suspected coronary artery disease (CAD).MethodsWe considered 196 consecutive patients (62.74 +/- 10.66 years, 49 females). Wall motion and perfusion abnormalities at rest and peak stress were analysed. Replacement myocardial fibrosis was detected by late gadolinium enhancement (LGE) technique. The ESPVR was evaluated at rest and peak stress from raw measurement of systolic arterial pressure and end-systolic volume by biplane Simpson's method.ResultsA reduced Delta ESPVR index (<= 0.02 mmHg/mL/m2) was found in 88 (44.9%) patients and it was associated with a lower LV ejection fraction (EF) and with a higher frequency of abnormal stress CMR and myocardial fibrosis. During a mean follow-up of 53.17 +/- 28.21 months, 50 (25.5%) cardiac events were recorded: 5 cardiac deaths, 17 revascularizations, one myocardial infarction, 23 hospitalisations for heart failure or unstable angina, and 4 ventricular arrhythmias. According to Cox regression analysis, diabetes, family history, LVEF, abnormal stress CMR, myocardial fibrosis, and reduced Delta ESPVR were significant univariate prognosticators. In the multivariate analysis the independent predictors were Delta ESPVR index <= 0.02 mmHg/mL/m2 (hazard ratio-HR = 2.58, P = 0.007), myocardial fibrosis (HR = 2.13, P = 0.036), and diabetes (HR = 2.33, P = 0.012).Conclusion Delta ESPVR index by stress-CMR was independently associated with cardiac outcomes in patients with known/suspected CAD, in addition to replacement myocardial fibrosis and diabetes. Thus, the assessment of Delta ESPVR index may be included into the standard stress-CMR exam to further stratify the patients.