Abstract

Objective: End-systolic pressure-volume relationship (ESPVR) is a useful method to assess left ventricular contractility during stress providing prognostic information above and beyond regional wall motion. Aim of the study was to assess the prognostic value of ESPVR in diabetic patients with negative dobutamine stress echocardiography by wall motion criteria.

Design: We enrolled 233 diabetic patients (140 males; mean (SD) age 67 (9) years; mean (SD) ejection fraction 52 (10)) with a negative dobutamine (up to 40 mcg/kg/min with atropine 1 mg) stress echocardiography. In all, ESPVR was determined at rest and at peak of stress as the ratio of peak systolic pressure and end-systolic volume (SP/ESV) index.

Setting: Adult diabetic patients evaluated at a tertiary care centre.

Main outcome measures: Death, STEMI, NSTEMI, and late (>6 months) revascularization.

Results: During a median of 18 months, 62 events occurred: 35 deaths, 4 STEMI, 5 NSTEMI, and 18 late revascularizations. Event-free survival was lower (p=0.006) in patients with peak SP/ESV index ≤ 28 mmHg/ml/m2, chosen with a receiver-operating characteristic curve. Multivariable indicators of future events were prior angioplasty (HR 2.10, 95% CI 1.17-3.77; p=0.01), rest wall motion abnormality (HR 1.94, 95% CI 1.12-3.36; p=0.02), and peak SP/ESV index ≤28 mmHg/ml/m2 (HR 2.28, 95% CI 1.08-4.81; p=0.03). At incremental analysis, peak SP/ESV index ≤ 28 mmHg/ml/m2 added prognostic information to that of clinical and resting echo findings.

Conclusions: Diabetic patients with negative dobutamine stress echocardiography may still experience an adverse outcome, which can be identified by ESPRV providing a prognostic stratification incremental over that supplied by regional wall motion abnormalities.