title: End-systolic elastance and ventricular-arterial coupling reserve predict cardiac events in patients with negative stress echocardiography.
abstract: BACKGROUND
  A maximal negative stress echo identifies a low-risk subset for coronary events. However, the potentially prognostically relevant information on cardiovascular hemodynamics for heart-failure-related events is unsettled. Aim of this study was to assess the prognostic value of stress-induced variation in cardiovascular hemodynamics in patients with negative stress echocardiography.
  
  
  METHODS
  We enrolled 891 patients (593 males mean age 63 ± 12, ejection fraction 48 ± 17%), with negative (exercise 172, dipyridamole 482, and dobutamine 237) stress echocardiography result. During stress we assessed left ventricular end-systolic elastance index (E(LV)I), ventricular arterial coupling (VAC) indexed by the ratio of the E(LV)I to arterial elastance index (E aI), systemic vascular resistance (SVR), and pressure-volume area (PVA). Changes from rest to peak stress (reserve) were tested as predictors of main outcome measures: combined death and heart failure hospitalization.
  
  
  RESULTS
  During a median followup of 19 months (interquartile range 8-36), 50 deaths and 84 hospitalization occurred. Receiver-operating-characteristic curves identified as best predictors E(LV)I reserve for exercise (AUC = 0.871) and dobutamine (AUC = 0.848) and VAC reserve (AUC = 0.696) for dipyridamole.
  
  
  CONCLUSIONS
  Patients with negative stress echocardiography may experience an adverse outcome, which can be identified by assessment of E(LV)I reserve and VAC reserve during stress echo.
authors.affiliation: Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy.
authors.forename: Tonino
authors.initials: T
authors.lastname: Bombardini
authors.forename: Marco Fabio
authors.initials: MF
authors.lastname: Costantino
authors.forename: Rosa
authors.initials: R
authors.lastname: Sicari
authors.forename: Quirino
authors.initials: Q
authors.lastname: Ciampi
authors.forename: Lorenza
authors.initials: L
authors.lastname: Pratali
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000473:pathology* / Q000517:prevention & control; D004176:Dipyridamole / Q000008:administration & dosage; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013315:Stress, Psychological / Q000188:drug therapy / Q000473:pathology*
chemical_list: D004280:Dobutamine; D004176:Dipyridamole
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