Long-term prognostic importance of transient left ventricular dilation during pharmacologic stress echocardiography

Objectives We sought to evaluate the prognostic significance of left ventricular (LV) transient ischemic dilation (TID) for patients with a positive stress echocardiogram (SE). Background TID during SE has been related to the presence of extensive coronary artery disease, but its long-term prognostic implications have not been reported. Methods In all, 99 consecutive patients with a positive SE comprised the study group. LV volumes were evaluated according to the modified Simpson's rule. TID during SE was defined as the presence of an increase in LV end-diastolic volume during the stress test. A clinical history was fulfilled for each patient and all of them were followed up. Results Of 99 patients, 32 (32.3%) showed TID. Mean age was 65.8 ± 9.8 years for non-TID group and 70.2 ± 8.4 for TID group ( P = .048). Baseline characteristics and subsequent treatment were similar in both groups. Mean follow-up was 21.4 ± 15.8 months. In non-TID group the mean survival free of acute myocardial infarction was 47.28 months and 39.7 months in TID group (log rank=0.012). In the univariate and multivariate analysis only TID and the wall motion score index were found as independent predictors related to long-term prognosis (risk ratio=6.9; 95% confidence interval=0.8-59.6; P = .042; and risk ratio=0.4; 95% confidence interval=0.18-0.89; P = .047, respectively). Conclusions LV TID during SE is an easy and independent prognostic marker. It helps to select patients with increased risk.