Abstract 2725: Increase in End-Systolic Volume with Exercise Independently Predicts Mortality: Data from the Heart & Soul Study
BACKGROUND: The predictive value of changes in global left ventricular (LV) size with exercise has not been studied. LV end-systolic volume (ESV) is a unique echocardiographic parameter that is determined by the interaction of preload, afterload, and contractility. We hypothesized that changes in ESV after exercise predict mortality.
METHODS: We performed exercise treadmill testing with stress echocardiography in 934 subjects with stable coronary artery disease. ESV was measured immediately before and after exercise. We defined ESV reversal as an increase in ESV after exercise. We used Cox proportional hazards models to examine the association of ESV reversal with all-cause mortality during an average follow-up of 3.5 years.
RESULTS: Of the 934 subjects, 199 (21%) had ESV reversal. Participants with ESV reversal were more likely to die than those without ESV reversal (26% vs. 11%; p < 0.001). After adjustment for traditional cardiovascular risk factors, ESV reversal remained predictive of all-cause mortality (HR 1.9; 95% CI 1.3–2.7; p = 0.001). After further adjustment for the presence of exercise-induced wall motion abnormalities, ESV reversal was still associated with mortality (HR 1.5; 95% CI 1.06–2.3, p = 0.02). To determine if the effect of ESV reversal was independent from other echocardiographic measurements, we created a separate model adjusted for resting LV EF, ESV, end-diastolic volume, mass, E and A wave height, and pulmonary vein flow. ESV reversal was the only significant predictor of mortality in this model (HR 2.1, 95% CI 1.4–3.0, p < 0.001).
CONCLUSION: ESV reversal is a potent independent predictor of mortality in patients with CAD, even after adjustment for a wide range of clinical and echocardiographic variables. Identification of ESV reversal during exercise echocardiography may be useful for risk stratification.