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Reduced end-systolic pressure-volume ratio response to exercise


Jellis, CL and Jenkins, C and Leano, R and Martin, JH and Marwick, TH, Reduced end-systolic pressure-volume ratio response to exercise, Circulation: Cardiovascular Imaging, 3, (4) pp. 443-449. ISSN 1941-9651 (2010) [Refereed Article]

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Copyright 2010 American Heart Association

DOI: doi:10.1161/CIRCIMAGING.109.934273


Background—Limitations in the predictive value of negative exercise echocardiography in type 2 diabetes mellitus has been linked to a reduced end-systolic pressure-volume response (ESPVR). We sought whether abnormal ESPVR reflected subclinical diabetic heart disease by examining the association between the ESPVR and markers of myocardial dysfunction and to establish if the change (Δ) or peak systolic blood pressure/end-systolic left ventricular volume ratio (SP/ESV) is a better marker of contractile reserve in type 2 diabetes mellitus.
Methods and Results—Resting and exercise echocardiography was performed in 167 apparently healthy patients with type 2 diabetes mellitus (97 men; age, 55±10 years) without ischemia, other cardiac disease, or noncardiac complications of diabetes. Standard echocardiographic and color tissue Doppler measures (early diastolic tissue velocity, strain, and strain rate) were acquired at baseline and peak stress in apical long-axis views. Calibrated integrated backscatter was calculated from a resting parasternal long-axis view. ΔSP/ESV was calculated as [(peak stress SP/ESV)(rest SP/ESV)]. The 83 subjects who demonstrated a ΔSP/ESV ≤12 mm Hg/mL/m2 after exercise were older and had lower peak heart rate, resting diastolic and stress systolic tissue velocity, stress ejection fraction, and exercise capacity than the remainder. There was no significant association between ΔSP/ESV and metabolic derangement or echocardiographic measures of deformation or backscatter. Change in Sm and stress ejection fraction were independent correlates of ΔSP/ESV.
Conclusions—ΔSP/ESV ratio is associated with established features of subclinical diabetic heart disease as well as determinants of contractile reserve (peak hemodynamic response and stress systolic function). Peak ESPVR is poorly associated with markers of myocardial dysfunction.

Item Details

Item Type:Refereed Article
Keywords:diabetes mellitus type 2, blood pressure, end-systolic volume, exercise echocardiography
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Cardiology (incl. cardiovascular diseases)
Objective Division:Health
Objective Group:Clinical health
Objective Field:Clinical health not elsewhere classified
UTAS Author:Marwick, TH (Professor Tom Marwick)
ID Code:90867
Year Published:2010
Web of Science® Times Cited:15
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-04-29
Last Modified:2014-05-02

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