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BioMed Research International
Volume 2013 (2013), Article ID 235194, 14 pages
Clinical Study

End-Systolic Elastance and Ventricular-Arterial Coupling Reserve Predict Cardiac Events in Patients with Negative Stress Echocardiography

1Institute of Clinical Physiology, National Research Council, Via Moruzzi 1, 56124 Pisa, Italy
2Cardiology Department, San Carlo Hospital, Via Potito Petrone, 85100 Potenza, Italy
3Division of Cardiology, Fatebenefratelli Hospital, Viale Principe di Napoli 12, 82100 Benevento, Italy

Received 26 April 2013; Accepted 1 July 2013

Academic Editor: Tong Tang

Copyright © 2013 Tonino Bombardini et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


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 , ejection fraction ), with negative (exercise 172, dipyridamole 482, and dobutamine 237) stress echocardiography result. During stress we assessed left ventricular end-systolic elastance index ( ), ventricular arterial coupling (VAC) indexed by the ratio of the to arterial elastance index ( ), 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 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 reserve and VAC reserve during stress echo.