Depressed Exercise Peak Ejection Rate Detected on Ambulatory Radionuclide Monitoring Reflects End-Stage Cardiac Inotropic Reserve and Predicts Mortality in Ischaemic Cardiomyopathy

Gian Piero Carboni

Abstract


Background: Fifteen patients with ischaemic cardiomyopathy and inducible ischaemia were studied to determine the mechanisms of mortality. Failure of the contractile reserve during daily life activities may reflect a prognostic index.

Methods: Single photon emission cardiac tomography and radionuclide ambulatory monitoring (Vest) data were analysed in all patients with a 7-year follow-up.

Results: At peak exercise on Vest, the 7 non-survivors (N-SURV) showed worse peak ejection rates (PERs) and ejection fractions (EFs) compared with the 8 survivors (SURV), (2 0.6 vs. 3.3 0.7; end-diastolic volumes (EDVs), P < 0.003), and (34 10% vs. 50 13%; P < 0.02), respectively. However, exercise peak filling rates (PFRs) (1.9 0.6 vs. 2.7 0.9; EDVs/s) and exercise heart rates (HRs), (97 17 vs. 106 10), did not differ between the two groups (P > 0.05). In SURV, exercise PERs, which represented rapid left ventricular (LV) emptying, were significantly correlated with exercise PFRs, representing rapid LV filling, (r = 0.71, P < 0.04) but not in N-SURV (r = 0.66, P > 0.05). Among SURV, the Frank-Starling mechanism was thus preserved but not in N-SURV. Upon Cox analysis, overall LV function parameters, exercise PER was the only predictive measure associated with mortality (b = - 0.018, relative hazard ratio = 0.98, P = 0.02).

Conclusions: Exercise PER reduced values reflected failure of the Frank-Starling mechanism, the incapacity of the heart to perform rapid contractile adaptations to daily life activities and a poor prognosis.




doi: http://dx.doi.org/10.4021/cr203w


Keywords


Peak ejection rate; Ambulatory radionuclide monitoring; Vest; Ischaemic cardiomyopathy

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