title: Pressure-volume Relationship in the Stress-echocardiography Laboratory: Does (Left Ventricular End-diastolic) Size Matter?
abstract: OBJECTIVE
  The variation between rest and peak stress end-systolic pressure-volume relation is an afterload-independent index of left ventricular contractility. Whether and to what extent it depends on end-diastolic volume remains unclear. The aim of this study was to assess the dependence of the delta rest-stress end-systolic pressure-volume relation on end-diastolic volume in patients with negative stress echo and all ranges of resting left ventricular function.
  
  
  METHODS
  We analyzed interpretable data obtained in 891 patients (593 men, age 63 ± 12 years) with ejection fraction 47% ± 12%: 338 were normal or near-normal or hypertensive; 229 patients had coronary artery disease; and 324 patients had ischemic or nonischemic dilated cardiomyopathy. They were studied with exercise (n = 172), dipyridamole (n = 482) or dobutamine (n = 237) stress echocardiography. The end-systolic pressure-volume relation was evaluated at rest and peak stress from raw measurement of systolic arterial pressure by cuff sphygmomanometer and end-systolic volume by biplane Simpson rule 2-dimensional echocardiography.
  
  
  RESULTS
  Absolute values of delta rest-stress end-systolic pressure-volume relation were higher for exercise and dobutamine than for dipyridamole. In the overall population, an inverse relationship between end-systolic pressure-volume relation and end-diastolic volume was present at rest (r2= 0.69, P < .001) and peak stress (r2= 0.56, P < .001), but was absent if the delta rest-stress end-systolic pressure-volume relation was considered (r2= 0.13).
  
  
  CONCLUSIONS
  Left ventricular end-diastolic volume does not affect the rest-stress changes in end-systolic pressure-volume relation in either normal or abnormal left ventricles during physical or pharmacological stress.
authors.affiliation: Cardiovascular Medicine Division, Cardiothoracic and Vascular Department, University of Pisa, Italy. Electronic address: tbombardini@yahoo.it.
authors.forename: Tonino
authors.initials: T
authors.lastname: Bombardini
authors.affiliation: Department of Molecular Physiology & Biophysics, University of Vermont, Burlington, Vermont, United States.
authors.forename: Louis A
authors.initials: LA
authors.lastname: Mulieri
authors.affiliation: Epidemiology and Health Services Research Department, Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Salvadori
authors.affiliation: Heart and Great Vessels Department, San Carlo Hospital, Potenza, Italy.
authors.forename: Marco Fabio
authors.initials: MF
authors.lastname: Costantino
authors.affiliation: Cardiovascular Medicine Division, Cardiothoracic and Vascular Department, University of Pisa, Italy.
authors.forename: Maria Chiara
authors.initials: MC
authors.lastname: Scali
authors.affiliation: Cardiovascular Medicine Division, Cardiothoracic and Vascular Department, University of Pisa, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Marzilli
authors.affiliation: Nazarbayev University School of Medicine, Astana, Kazakhstan.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
mesh_terms: D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000503:physiopathology; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology; D003971:Diastole; D025401:Echocardiography, Stress / Q000379:methods*; D015444:Exercise / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*; D017725:Ventricular Pressure / Q000502:physiology*
keywords: Contractilidad; Contractility; Diastole; Diástole; Ecocardiografía de estrés; Fisiología; Physiology; Stress echocardiography