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

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Abstract

Purpose

The difference between rest and peak stress end-systolic pressure-volume relation (ΔESPVR) is an afterload-independent index of left ventricular (LV) contractility. We assessed the independent prognostic value of ΔESPVR index by dipyridamole stress-cardiovascular magnetic resonance (CMR) in patients with known/suspected coronary artery disease (CAD).

Methods

We 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.

Results

A reduced ΔESPVR 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 ΔESPVR were significant univariate prognosticators. In the multivariate analysis the independent predictors were ΔESPVR 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

ΔESPVR 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 ΔESPVR index may be included into the standard stress-CMR exam to further stratify the patients.

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Acknowledgements

We thank Claudia Santarlasci for her skillful secretarial work and all patients for their cooperation.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. Antonella Meloni and Antonio De Luca joint first authorship.

Authors and Affiliations

  1. Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, Pisa, 56124, Italy

    Antonella Meloni, Filippo Cademartiri & Alessia Pepe

  2. Department of Bioengineering, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy

    Antonella Meloni

  3. Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy

    Antonio De Luca, Chiara Cappelletto & Gianfranco Sinagra

  4. Division of Cardiology, University Hospital “P. Giaccone”, University of Palermo, Palermo, Italy

    Cinzia Nugara & Giuseppina Novo

  5. IRCSS Centro Neurolesi Bonino Pulejo, Messina, Italy

    Cinzia Nugara

  6. Cardiovascular Department, University Campus Bio-Medico, Roma, Italy

    Camilla Cavallaro & Francesco Grigioni

  7. Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy

    Andrea Barison, Giancarlo Todiere, Chrysanthos Grigoratos & Michele Emdin

  8. Institute of Life Sciences, Scuola Superiore Sant’Anna, Pisa, Italy

    Michele Emdin

  9. Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece

    Sophie Mavrogeni

  10. Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy

    Emilio Quaia & Alessia Pepe

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  1. Antonella Meloni
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  2. Antonio De Luca
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  3. Cinzia Nugara
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  8. Chrysanthos Grigoratos
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  9. Giuseppina Novo
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Contributions

A.M.: conceptualization, formal analysis, investigation, methodology, writing - original draft; A.D.L.: formal analysis, writing - original draft; C.N., C.C., Ch. C.: data curation, writing - review & editing; A.B., G.T., C.G.: formal analysis, resources, writing - review & editing; G.N., F.G., M.E., G.S., S.M., E.Q., F.C.: supervision, writing - review & editing; A.P.: conceptualization, methodology, resources, supervision, writing - review & editing.

Corresponding author

Correspondence to Alessia Pepe.

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This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Area Vasta Nord Ovest (Pisa)”.

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Meloni, A., De Luca, A., Nugara, C. et al. The additive prognostic value of end-systolic pressure-volume relation by stress CMR in patients with known or suspected coronary artery disease. Int J Cardiovasc Imaging (2024). https://doi.org/10.1007/s10554-024-03104-z

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