The value of a simplified approach to end-systolic volume measurement for assessment of left ventricular contractile reserve during stress-echocardiography
- 22 Downloads
The peak stress/rest ratio of left ventricular (LV) elastance, or LV force, is a load-independent index of left ventricular contractile reserve (LVCR) with stress echo (SE). To assess the accuracy of LVCR calculated during SE with approaches of different complexity. Two-hundred-forty patients were referred to SE for known or suspected coronary artery disease or heart failure and, of those, 200 patients, age 61 ± 15, 99 females, with interpretable volumetric SE were enrolled. All readers had passed the upstream quality control reading for regional wall motion abnormality (RWMA) and end-systolic volume (ESV) measurement. The employed stress was dipyridamole (0.84 mg, 6 min) in 86 (43%) and dobutamine (up to 40 mcg/kg/min) in 114 (57%) patients. All underwent SE with evaluation of RWMA and simultaneous LVCR assessment with stress/rest ratio of LV force (systolic blood pressure by cuff sphygmomanometer/ESV). ESV was calculated in each patient by two of three methods: biplane Simpson rule (S, in 100 patients), single plane area-length (AL, apical four-chamber area and length, in 100 patients), and Teichholz rule (T, from parasternal long axis and/or short axis view, in 200 patients). RMWA were observed in 54 patients. Success rate for ESV measurement was 76% (100/131) for S, 92% (100/109) for AL, and 100% (240/240) for T. There were 100 paired measurements (rest and stress) with S versus T, and 100 with AL versus T. The analysis time was the shortest for T (33 ± 8 s at rest, 34 ± 7 s at stress), intermediate for AL (70 ± 22 s at rest 67 ± 21 s at stress), and the longest for S (136 ± 24 at rest 129 ± 27 s at stress, p < 0.05 vs. T and AL). ESV absolute values were moderately correlated: T versus S (r rest = 0.746, p < 0.01, n = 100; r stress = 0.794, p < 0.01, n = 100); T vs. AL (r = 0.603 p < 0.01, n = 100, at rest and r = 0.820 p < 0.01 n = 100 at peak stress). LVCR values were tightly correlated independently of the method employed: T versus S (r = 0.899, p < 0.01, n = 100), and T versus AL (r = 0.845, p < 0.01, n = 100). LVCR can be accurately determined with all three methods used to extract the raw values of ESV necessary to generate the calculation of Force. Although S is known to be more precise in determining absolute ESV values, the relative (rest-stress) changes can be assessed, with comparable accuracy, with simpler and more feasible T and AL methods, characterized by higher success rate, shorter imaging and analysis time.
KeywordsLeft ventricular contractility Echocardiography Stress
Coronary artery disease
Left ventricular contractile reserve
Regional wall motion abnormalities
Wall motion score index
Ageing project of Italian national Research Council (GAE P001328).
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
- 3.Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A (2016) The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 17:1191–1229CrossRefGoogle Scholar
- 10.Cortigiani L, Bombardini T, Corbisiero A, Mazzoni A, Bovenzi F, Picano E (2009) The additive prognostic value of end-systolic pressure-volume relation in patients with diabetes mellitus having negative dobutamine stress echocardiography by wall motion criteria. Heart 95:1429–1435CrossRefGoogle Scholar
- 12.Cortigiani L, Huqi A, Ciampi Q, Bombardini T, Bovenzi F, Picano E (2018) Integration of Wall Motion, Coronary Flow Velocity, and Left Ventricular Contractile Reserve in a Single Test: prognostic Value of Vasodilator Stress Echocardiography in Patients with Diabetes. J Am Soc Echocardiogr 31:692–701CrossRefGoogle Scholar
- 13.Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, Flachskampf FA, Foster E, Goldstein SA, Kuznetsova T, Lancellotti P, Muraru D, Picard MH, Rietzschel ER, Rudski L, Spencer KT, Tsang W, Voigt JU (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39. e14CrossRefGoogle Scholar
- 17.Picano E, Ciampi Q, Citro R, D’Andrea A, Scali MC, Cortigiani L, Olivotto I, Mori F, Galderisi M, Costantino MF, Pratali L, Di Salvo G, Bossone E, Ferrara F, Gargani L, Rigo F, Gaibazzi N, Limongelli G, Pacileo G, Andreassi MG, Pinamonti B, Massa L, Torres MAR, Miglioranza MH, Daros CB, de Castro e Silva Pretto JL, Beleslin B, Djordjevic-Dikic A, Varga A, Palinkas A, Agoston G, Gregori D, Trambaiolo P, Severino S, Arystan A, Paterni M, Carpeggiani C, Colonna P (2017) Stress echo 2020: the international Stress Echo study in ischemic and non-ischemic heart disease. Cardiovasc Ultrasound. https://doi.org/10.1186/s12947-016-0092-1 Google Scholar
- 18.Ciampi Q, Picano E, Paterni M, Borguezan Daros C, Simova I, de Castro e Silva Pretto JL, Scali MC, Gaibazzi N, Severino S, Djordjevic-Dikic A, Kasprzak J, Zagatina A, Varga A, Lowenstein J, Merlo PM, Amor M, Celeutkiene J, Perez J, Di Salvo G, Galderisi M, Mori F, Costantino FM, Massa L, Dekleva M, Quesada Chavez D, Trambaiolo P, Citro R, Colonna P, Rigo F, Torres ARM, Monte I, Stankovic I, Neskovic A, Cortigiani L, Re F, Dodi C, D’Andrea A, Villari B, Arystan A, De Nes M, Carpeggiani C, on behalf of Stress Echo 2020 study group of the Italian Society of Cardiovascular Echography (2017) Quality Control of Regional Wall Motion Analysis in Stress echo 2020. Int J Cardiol 249:479–485CrossRefGoogle Scholar
- 19.Carpeggiani C, Ciampi Q, Paterni M, De Nes M, Zagatina A, Simova I, Djordievic-Dikic A, Citro R, Colonna P, Picano E (2019) Multi-step Web-based Training: the road to Stress echo 2020. Arg J Cardiol 86(6):404–409Google Scholar
- 20.Hinkle DE, Wiersma W, Jurs SG (2003) Applied statistics for the behavioral sciences. Houghton Mifflin College Division, Boston, p 756Google Scholar
- 24.Kataoka A, Scherrer-Crosbie M, Senior R, Gosselin G, Phaneuf D, Guzman G, Perna G, Lara A, Kedev S, Mortara A, El-Hajjar M, Shaw LJ, Reynolds HR, Picard MH (2015) The value of core lab stress echocardiography interpretations: observations from the ISCHEMIA Trial. Cardiovasc Ultrasound 13(1):47CrossRefGoogle Scholar
- 25.Thavendiranathan P, Popović ZB, Flamm SD, Dahiya A, Grimm RA, Marwick TH (2013) Improved interobserver variability and accuracy of echocardiographic visual left ventricular ejection fraction assessment through a self-directed learning program using cardiac magnetic resonance images. J Am Soc Echocardiogr 26:1267–1273CrossRefGoogle Scholar
- 29.Grossgasteiger M, Hien MD, Graser B, Rauch H, Motsch J, Gondan M, Rosendal C (2014) Image quality influences the assessment of left ventricular function: an intraoperative comparison of five 2-dimensional echocardiographic methods with real-time 3-dimensional echocardiography as a reference. Ultrasound Med. 33(2):297–306. https://doi.org/10.7863/ultra.33.2.297 CrossRefGoogle Scholar