BACKGROUND: Quantitative stress echocardiography enables calculation of left-ventricular power-to-mass ratio (LVPMR) at peak exercise, a novel measure of cardiac performance per unit mass of myocardial tissue. We hypothesized that LVPMR at peak exercise provides prognostic information beyond established echocardiographic indices such as left-ventricular ejection fraction (LVEF) and left-ventricular mass index (LVMI). METHODS: LVPMR (watts/kilogram) at peak exercise was defined as (k x heart rate x mean arterial pressure x stroke volume)/LV mass. We measured LVPMR in 918 adults with stable ambulatory coronary artery disease recruited for the Heart and Soul Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for all-cause mortality, cardiovascular death, nonfatal myocardial infarction, heart failure hospitalization, and combined adverse cardiovascular events. Multivariate adjustments were made for established risk factors including LVEF and LVMI. The prognostic value of LVPMR was also compared with established exercise parameters using receiver-operating characteristic curve analysis. RESULTS: Compared with patients in the highest LVPMR quartile, those in the lowest quartile were at increased risk of all-cause mortality (adjusted HR 1.9; 95% CI 1.1-3.3), heart failure hospitalization (adjusted HR 2.9; 95% CI 1.2-6.9), and combined adverse cardiovascular events (adjusted HR 1.9; 95% CI 1.1-3.4). In comparison with the rate-pressure product and the Duke treadmill score, LVPMR did not add significant prognostic value (p > 0.1 for c-statistic comparisons). CONCLUSIONS: In patients with stable ambulatory coronary artery disease, LVPMR at peak exercise predicts mortality, heart failure hospitalization, and adverse cardiovascular events. However, LVPMR does not add significant prognostic information beyond established exercise test parameters. Copyright 2009 S. Karger AG, Basel.
BACKGROUND: Quantitative stress echocardiography enables calculation of left-ventricular power-to-mass ratio (LVPMR) at peak exercise, a novel measure of cardiac performance per unit mass of myocardial tissue. We hypothesized that LVPMR at peak exercise provides prognostic information beyond established echocardiographic indices such as left-ventricular ejection fraction (LVEF) and left-ventricular mass index (LVMI). METHODS: LVPMR (watts/kilogram) at peak exercise was defined as (k x heart rate x mean arterial pressure x stroke volume)/LV mass. We measured LVPMR in 918 adults with stable ambulatory coronary artery disease recruited for the Heart and Soul Study. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for all-cause mortality, cardiovascular death, nonfatal myocardial infarction, heart failure hospitalization, and combined adverse cardiovascular events. Multivariate adjustments were made for established risk factors including LVEF and LVMI. The prognostic value of LVPMR was also compared with established exercise parameters using receiver-operating characteristic curve analysis. RESULTS: Compared with patients in the highest LVPMR quartile, those in the lowest quartile were at increased risk of all-cause mortality (adjusted HR 1.9; 95% CI 1.1-3.3), heart failure hospitalization (adjusted HR 2.9; 95% CI 1.2-6.9), and combined adverse cardiovascular events (adjusted HR 1.9; 95% CI 1.1-3.4). In comparison with the rate-pressure product and the Duke treadmill score, LVPMR did not add significant prognostic value (p > 0.1 for c-statistic comparisons). CONCLUSIONS: In patients with stable ambulatory coronary artery disease, LVPMR at peak exercise predicts mortality, heart failure hospitalization, and adverse cardiovascular events. However, LVPMR does not add significant prognostic information beyond established exercise test parameters. Copyright 2009 S. Karger AG, Basel.
Authors: Paul Knaapen; Tjeerd Germans; Juhani Knuuti; Walter J Paulus; Pieter A Dijkmans; Cornelis P Allaart; Adriaan A Lammertsma; Frans C Visser Journal: Circulation Date: 2007-02-20 Impact factor: 29.690
Authors: M L Chuang; M G Hibberd; C J Salton; R A Beaudin; M F Riley; R A Parker; P S Douglas; W J Manning Journal: J Am Coll Cardiol Date: 2000-02 Impact factor: 24.094
Authors: Abdou Elhendy; Karen M Modesto; Douglas W Mahoney; Bijoy K Khandheria; James B Seward; Patricia A Pellikka Journal: J Am Coll Cardiol Date: 2003-01-01 Impact factor: 24.094
Authors: N B Schiller; C G Skiôldebrand; E J Schiller; C C Mavroudis; N H Silverman; S H Rahimtoola; M J Lipton Journal: Circulation Date: 1983-07 Impact factor: 29.690
Authors: Bernice Ruo; John S Rumsfeld; Mark A Hlatky; Haiying Liu; Warren S Browner; Mary A Whooley Journal: JAMA Date: 2003-07-09 Impact factor: 56.272
Authors: Rupert Fincke; Judith S Hochman; April M Lowe; Venu Menon; James N Slater; John G Webb; Thierry H LeJemtel; Gad Cotter Journal: J Am Coll Cardiol Date: 2004-07-21 Impact factor: 24.094
Authors: Meyeon Park; Eric Vittinghoff; Michael G Shlipak; Rakesh Mishra; Mary Whooley; Nisha Bansal Journal: Am Heart J Date: 2014-10-14 Impact factor: 4.749