title: Echocardiographic markers of inducible myocardial ischemia at baseline evaluation preparatory to exercise stress echocardiography.
abstract: BACKGROUND
  Tissue Doppler Imaging (TDI) is a sensible and feasible method to detect longitudinal left ventricular (LV) systolic dysfunction (LVSD) in patients with diabetes mellitus, hypertension or ischemic heart disease. In this study, we hypothesized that longitudinal LVSD assessed by TDI predicted inducible myocardial ischemia independently of other echocardiographic variables (assessed as coexisting potential markers) in patients at increased cardiovascular (CV) risk.
  
  
  METHODS
  Two hundred one patients at high CV risk defined according to the ESC Guidelines 2012 underwent exercise stress echocardiography (ExSEcho) for primary prevention. Echocardiographic parameters were measured at rest and peak exercise.
  
  
  RESULTS
  ExSEcho classified 168 (83.6 %) patients as non-ischemic and 33 (16,4 %) as ischemic. Baseline clinical characteristics were similar between the groups, but ischemic had higher blood pressure, received more frequently beta-blockers and antiplatelet agents than non-ischemic patients. The former had greater LV size, lower relative wall thickness and higher left atrial systolic force (LASF) than the latter. LV systolic longitudinal function (measure as peak S') was significantly lower in ischemic than non-ischemic patients (8.7 ± 2.1 vs 9.7 ± 2.7 cm/sec, p = 0.001). The factors independently related to myocardial ischemia at multivariate logistic analysis were: lower peak S', higher LV circumferential end-systolic stress and LASF.
  
  
  CONCLUSIONS
  In asymptomatic patients at increased risk for adverse CV events baseline longitudinal LVSD together with higher LV circumferential end-systolic stress and LASF were the factors associated with myocardial ischemia induced by ExSEcho. The assessment of these factors at standard echocardiography might help the physicians for improving the risk stratification among these patients for ExSEcho.
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Cherubini
authors.affiliation: Cardiology Department Villa Bianca Hospital, Trento, Italy. gcioffi@villabiancatrento.it.|Echocardiography Laboratory, Villa Bianca Hospital, via Piave 78, 38100, Trento, Italy. gcioffi@villabiancatrento.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Mazzone
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Faganello
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.affiliation: Cardiology Department St. Martino Hospital Azienda Sanitaria Locale n. 1, Belluno, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Russo
authors.affiliation: Cardiology Department Villa Bianca Hospital, Trento, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Stefenelli
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Humar
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Eliana
authors.initials: E
authors.lastname: Grande
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fisicaro
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Pandullo
authors.affiliation: Cardiovascular Center, Health Authority n° 1 and University of Trieste, Trieste, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
mesh_terms: D000368:Aged; D015150:Echocardiography, Doppler / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Cardiovascular risk; Exercise stress test; Inducible myocardial ischemia; Left ventricular systolic function; Longitudinal function