Meloni Antonella, De Luca Antonio, Nugara Cinzia, Cavallaro Camilla, Cappelletto Chiara, Barison Andrea, Todiere Giancarlo, Grigoratos Chrysanthos, Novo Giuseppina, Grigioni Francesco, Emdin Michele, Sinagra Gianfranco, Mavrogeni Sophie, Quaia Emilio, Cademartiri Filippo, Pepe Alessia
Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, Pisa, 56124, Italy.
Department of Bioengineering, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
Int J Cardiovasc Imaging. 2024 Jun;40(6):1341-1351. doi: 10.1007/s10554-024-03104-z. Epub 2024 Apr 27.
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).
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.
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).
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.
静息和峰值应力下的收缩末期压力-容积关系之差（ΔESPVR）是左心室（LV）收缩力的一种与后负荷无关的指标。我们通过双嘧达莫负荷心血管磁共振（CMR）评估了ΔESPVR指数在已知/疑似冠状动脉疾病（CAD）患者中的独立预后价值。
我们纳入了196例连续患者（62.74±10.66岁，49名女性）。分析了静息和峰值应力下的壁运动和灌注异常情况。通过延迟钆增强（LGE）技术检测替代性心肌纤维化。通过双平面辛普森法从收缩期动脉压和收缩末期容积的原始测量值评估静息和峰值应力下的ESPVR。
88例（44.9%）患者的ΔESPVR指数降低（≤0.02 mmHg/mL/m²），且与较低的左心室射血分数（EF）以及较高频率的异常负荷CMR和心肌纤维化相关。在平均53.17±28.21个月的随访期间，记录了50例（25.5%）心脏事件：5例心源性死亡、17例血管重建、1例心肌梗死、23例因心力衰竭或不稳定型心绞痛住院以及4例室性心律失常。根据Cox回归分析，糖尿病、家族史、左心室射血分数、异常负荷CMR、心肌纤维化和降低的ΔESPVR是显著的单变量预后因素。在多变量分析中，独立预测因素为ΔESPVR指数≤0.02 mmHg/mL/m²（风险比-HR = 2.58，P = 0.007）、心肌纤维化（HR = 2.13，P = 0.036）和糖尿病（HR = 2.33，P = 0.012）。
除了替代性心肌纤维化和糖尿病外，负荷CMR的ΔESPVR指数与已知/疑似CAD患者的心脏结局独立相关。因此，ΔESPVR指数的评估可纳入标准的负荷CMR检查，以进一步对患者进行分层。
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