Pressure-Volume Relationship by Pharmacological Stress Cardiovascular Magnetic Resonance

The variation between rest and peak stress end-systolic pressure-volume relation (Delta ESPVR) is an index of myocardial contractility, easily obtained during routine stress echocardiography and never tested during dipyridamole stress-cardiac magnetic resonance (CMR). We assessed the Delta ESPVR index in patients with known/suspected coronary artery disease (CAD) who underwent dipyridamole stress-CMR. One-hundred consecutive patients (24 females, 63.76 +/- 10.17 years) were considered. ESPVR index was evaluated at rest and stress from raw measurement of systolic arterial pressure and end-systolic volume by biplane Simpson's method. The Delta ESPVR index showed a good inter-operator reproducibility. Mean Delta ESPVR index was 0.48 +/- 1.45 mmHg/mL/m(2). Delta ESPVR index was significantly lower in males than in females. Delta ESPVR index was not correlated to rest left ventricular end-diastolic volume index or ejection fraction. Forty-six of 85 patients had myocardial fibrosis detected by the late gadolinium enhancement technique and they showed significantly lower Delta ESPVR values. An abnormal stress CMR was found in 25 patients and they showed significantly lower Delta ESPVR values. During a mean follow-up of 56.34 +/- 30.04 months, 24 cardiovascular events occurred. At receiver-operating characteristic curve analysis, a Delta ESPVR < 0.02 mmHg/mL/m2 predicted the presence of future cardiac events with a sensitivity of 0.79 and a specificity of 0.68. The noninvasive assessment of the Delta ESPVR index during a dipyridamole stress-CMR exam is feasible and reproducible. The Delta ESPVR index was independent from rest LV dimensions and function and can be used for a comparative assessment of patients with different diseases. Delta ESPVR index by CMR can be a useful and simple marker for additional prognostic stratification.