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

Antonella Meloni; Antonio De Luca; Cinzia Nugara; Camilla Cavallaro; Chiara Cappelletto; Andrea Barison; Giancarlo Todiere; Chrysanthos Grigoratos; Giuseppina Novo; Francesco Grigioni; Michele Emdin; Gianfranco Sinagra; Sophie Mavrogeni; Emilio Quaia; Filippo Cademartiri; Alessia Pepe

doi:10.1007/s10554-024-03104-z

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 Apr 27. doi: 10.1007/s10554-024-03104-z. Online ahead of print.

Authors

Antonella Meloni^#^{1

2}, Antonio De Luca^#³, Cinzia Nugara^{4

5}, Camilla Cavallaro⁶, Chiara Cappelletto³, Andrea Barison⁷, Giancarlo Todiere⁷, Chrysanthos Grigoratos⁷, Giuseppina Novo⁴, Francesco Grigioni⁶, Michele Emdin^{7

8}, Gianfranco Sinagra³, Sophie Mavrogeni⁹, Emilio Quaia¹⁰, Filippo Cademartiri¹, Alessia Pepe^{11

12}

Affiliations

¹ Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, Pisa, 56124, Italy.
² Department of Bioengineering, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
³ Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy.
⁴ Division of Cardiology, University Hospital "P. Giaccone", University of Palermo, Palermo, Italy.
⁵ IRCSS Centro Neurolesi Bonino Pulejo, Messina, Italy.
⁶ Cardiovascular Department, University Campus Bio-Medico, Roma, Italy.
⁷ Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
⁸ Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy.
⁹ Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
¹⁰ Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy.
¹¹ Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, Pisa, 56124, Italy. alessia.pepe@unipd.it.
¹² Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy. alessia.pepe@unipd.it.

^# Contributed equally.

PMID: 38676849
DOI: 10.1007/s10554-024-03104-z

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.

Keywords: Coronary artery disease; Heart contractility; Magnetic resonance imaging; Prognosis.