Pressure-Volume Relationship During Dobutamine Stress Echocardiography Predicts Exercise Tolerance in Patients with Congestive Heart Failure

Ciampi, Quirino; Pratali, Lorenza; Bombardini, Tonino; Della Porta, Michele; Petruzziello, Bruno; Villari, Bruno; Picano, Eugenio; Sicari, Rosa

doi:10.1016/j.echo.2009.11.001

« Previous Next »Journal of the American Society of Echocardiography
Volume 23, Issue 1 , Pages 71-78, January 2010

Pressure-Volume Relationship During Dobutamine Stress Echocardiography Predicts Exercise Tolerance in Patients with Congestive Heart Failure

Quirino Ciampi, MD, PhD
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
- Reprint requests: Quirino Ciampi, MD, PhD, Fatebenefratelli Hospital, Division of Cardiology, Viale Principe di Napoli, 12, I-82100, Benvenuto, Italy.
Lorenza Pratali, MD, PhD
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
Tonino Bombardini, MD
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
Michele Della Porta, MD
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
Bruno Petruzziello, MD
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
Bruno Villari, MD, PhD
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
Eugenio Picano, MD, PhD, FESC
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
Rosa Sicari, MD, PhD, FESC
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy

published online 04 December 2009.

Background

The pressure-volume relationship (PVR) is a useful method for evaluating left ventricular (LV) myocardial contractility during dobutamine stress echocardiography (DSE). The investigators assessed PVRs, systolic and diastolic function, B-type natriuretic peptide (BNP) levels, and aerobic exercise capacity in patients with congestive heart failure (CHF).

Methods

A total of 84 patients with CHF (mean age, 68 ± 9 years) underwent high-dose DSE. PVR was defined as the systolic cuff pressure/end-systolic volume index difference between rest and peak DSE. Of these, 67 patients also underwent cardiopulmonary exercise testing. The patients were divided into 3 equal groups on the basis of PVR: lower, intermediate, and higher.

Results

PVRs were significantly lower in more symptomatic patients (New York Heart Association class II vs III) (2.17 ± 1.99 vs 0.91 ± 0.72 mm Hg/mL/m², P < .001). Patients with elevated LV filling pressures (E/Ea ≥ 14) showed significantly lower PVRs compared with patients with normal or slightly abnormal LV filling pressures (1.1 ± 1.1 vs 2.96 ± 3.11 mm Hg/mL/m², P = .006). Patients with higher PVRs showed lower logarithmically transformed BNP levels (2.0 ± 0.5, 2.5 ± 0.3, and 2.6 ± 0.5 pg/mL; P < .001), higher peak oxygen consumption (17 ± 4, 13 ± 3, and 12 ± 3 mL/kg/min; P < .001), and higher rest-stress percentage changes in ejection fraction (80 ± 50%, 56 ± 29%, and 22 ± 32%; P < .001) compared with patients with intermediate and lower PVRs, respectively. The parameters predictive of exercise tolerance were PVR (odds ratio [OR]; 1.582, 95% confidence interval [CI], 1.136-2.204; P = .007), ejection fraction (OR, 1.172; 95% CI, 1.070-1.283; P = .001), log BNP (OR, 0.080; 95% CI, 0.020-0.325; P < .001), and E/Ea (OR, 0.836; 95% CI, 0.733-0.953; P = .007).

Conclusions

In patients with CHF, impaired noninvasively assessed myocardial contractility is related to impaired systolic and diastolic function, higher BNP levels, and poorer exercise tolerance.

Keywords: Dobutamine stress echocardiography, Contractile reserve, Heart failure, Exercise tolerance, Natriuretic peptides