QF3-06 - The additive prognostic value of end-systolic pressure-volume relation by stress CMR in patients with known or suspected coronary artery disease

Friday, February 14, 2020

3:05 PM – 3:08 PM

Location: Sabal/Sago (Meeting Room in Exhibit Hall)

Background: The variation between rest and peak stress end-systolic pressure-volume relation is an afterload-independent index of left ventricular contractility. This index is easily obtained during routine stress echocardiography but can be derived also during a stress cardiovascular magnetic resonance (CMR) exam, that is the gold standard for the quantification of biventricular volumes.
The aim of this study was to assess for the first time the prognostic value of delta rest-stress ESPVR (ΔESPVR) by dipyridamole stress-CMR in patients with known or suspected coronary artery disease (CAD).

Methods: One-hundred and ninety-six consecutive patients (49 females, mean age 62.74±10.66 years) who underwent dipyridamole stress-CMR in a high volume CMR Laboratory were considered.
Abnormal wall motion and perfusion at rest and after dipyridamole were analysed. Macroscopic myocardial fibrosis was detected by the late gadolinium enhancement (LGE) technique. The ESPVR was evaluated at rest and peak stress from raw measurement of systolic arterial pressure by cuff sphygmomanometer and end-systolic volume by biplane Simpson method.

Results: An abnormal stress CMR was found in 52 (26.5%) patients; 36 patients had a reversible stress perfusion defect in at least one myocardial segment and 16 a reversible stress perfusion defect plus worsening of stress wall motion in comparison with rest. LGE sequences were acquired in 170 (86.7%) patients and myocardial fibrosis was detected in 90 patients (52.9%). A ΔESPVR index≤0.02 mmHg/mL/m2 was found in 88 patients (44.9%).
Mean follow-up time was 53.17±28.21 months (median=49.61 months). Cardiac events were recorded in 50 (25.5%) patients: 5 cardiac deaths, 17 revascularizations for angina (N=14) or myocardial infarction (N=3), one myocardial infarction, 23 hospitalisations for heart failure (N=5) or unstable angina (n=18), and 4 ventricular arrhythmias. Table 1 shows the results of the univariate Cox analysis. Diabetes, family history, LVEF, abnormal stress CMR, myocardial fibrosis, and reduced ΔESPVR were significant univariate prognosticators. In the multivariate analysis the independent predictive factors were diabetes (HR=2.33, 95%CI=1.21-4.51, P=0.012), a ΔESPVR index≤0.02 mmHg/mL/m2 (HR=2.58, 95%CI=1.29-5.13, P=0.007), and myocardial fibrosis (HR=2.13, 95%CI=1.05-4.31, P=0.036). The Kaplan Meyer curves showing the impact of each prognostic factor on the development of cardiac events are shown in Figure 1. The log-rank test revealed a significant difference in all the curves (diabetes: P=0.016, ΔESPVR index≤0.02 mmHg/mL/m2: P< 0.0001, and myocardial fibrosis: P=< 0.0001).

Conclusion: ΔESPRV assessed by CMR provides a prognostic stratification in patients with known or suspected coronary artery disease, in addition to that supplied by diabetes and myocardial fibrosis.

Presenting Author(s)

Alessia Pepe, MD, PhD

Cardiologist and Radiologist
Fondazione G. Monasterio CNR-Regione Toscana

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Primary Author(s)

Alessia Pepe, MD, PhD

Cardiologist and Radiologist
Fondazione G. Monasterio CNR-Regione Toscana

Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

AD

Antonio De Luca, MD

University of Trieste

Disclosure: Disclosure information not submitted.
CN

Cinzia Nugara, MD

Cardiologist
University of Palermo

Disclosure: Disclosure information not submitted.
CC

Camilla Cavallaro, MD

Università Campus Bio-Medico

Disclosure: Disclosure information not submitted.
CC

Chiara Cappelletto, MD

University of Trieste

Disclosure: Disclosure information not submitted.
CG

Chrysanthos Grigoratos, MD, PhD

Cardiologist
Fondazione G. Monasterio CNR-Regione Toscana

Disclosure: Disclosure information not submitted.
GA

Giovanni Aquaro, MD

Cardiologist
Fondazione G. Monasterio CNR-Regione Toscana

Disclosure: Disclosure information not submitted.
AB

Andrea Barison, MD, PhD

Fondazione G. Monasterio CNR-Regione Toscana

Disclosure: Disclosure information not submitted.
GT

Giancarlo Todiere, MD

Cardiologist
University of Trieste

Disclosure: Disclosure information not submitted.
GN

Giuseppina Novo, MD, PhD

Associate Professor
University of Palermo

Disclosure: Disclosure information not submitted.
GS

Gianfranco Sinagra, MD

University of Trieste

Disclosure: Disclosure information not submitted.
GD

Germano Di Sciascio, MD

Università Campus Bio-Medico

Disclosure: Disclosure information not submitted.
Antonella Meloni

Biomedical Engineer
Fondazione G. Monasterio CNR-Regione Toscana

Disclosure: Disclosure information not submitted.