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Decoupling of Contractile Speed and Myocardial Work: Paradoxical Pressure-Strain Loop Responses to Dobutamine in High-Risk Patients
Session:
Sessão de Posters 44 - Miscelânea: genética, estratificação de risco e mecânica miocárdica
Speaker:
Lígia Mendes
Congress:
CPC 2026
Topic:
O. Basic Science
Theme:
36. Basic Science
Subtheme:
36.2 Basic Science - Cardiac Biology and Physiology
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Lígia Lopes Mendes; João Colaço; José Ferreira Santos; João Pereira; Ana Teresa Timóteo
Abstract
<p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Google Sans Text""><span style="color:black">Introduction:</span></span></span></strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Google Sans Text""><span style="color:black">While dobutamine stress typically increases cardiac output and contractility, its impact on myocardial energetics in patients with structural heart disease is complex. Non-invasive Pressure-Strain Loops (PSL) allow for the simultaneous assessment of deformation (Strain Rate) and total work (Global Work Index - GWI). This exploratory study investigated the hemodynamic response to dobutamine stress using PSL in a cohort of patients with established cardiovascular risk.</span></span></span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Google Sans Text""><span style="color:black">Methods:</span></span></span></strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Google Sans Text""><span style="color:black">We analysed an exploratory cohort of 11 patients (mean age 75 ± 10 years) with high cardiovascular risk burden, including 91% with hypertension or dyslipidemia and 55% with reduced contractile reserve or established disease. PSL acquisitions were performed at baseline and peak dobutamine stress. Within-subject changes were quantified using rank-biserial correlation (r) and Hodges-Lehmann median differences.</span></span></span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Google Sans Text""><span style="color:black">Results:</span></span></span></strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Google Sans Text""><span style="color:black">The cohort exhibited a heterogeneous but distinctive "decoupling" pattern between contractile speed and energetic work. Specifically, there was a robust increase in Global Systolic Strain Rate (Median change +0.23 s?¹, r=0.91), with 9 out of 11 (82%) patients classified as responders. Paradoxically, despite this increase in speed, the Global Work Index (GWI) significantly decreased (Median change -326 mmHg%, r=-0.88), with only 2 out of 11 patients showing increased work. This contrasts markedly with healthy volunteer data, where physiological stress typically increases both Strain Rate and GWI uniformly.</span></span></span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:11.0pt"><span style="font-family:"Google Sans Text""><span style="color:black">Conclusion:</span></span></span></strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:11.0pt"><span style="font-family:"Google Sans Text""><span style="color:black">In this exploratory high-risk cohort, dobutamine stress increased contractile speed (strain rate) but failed to augment, and often reduced, GWI. This divergence suggests that PSL analysis can detect a "decoupling" of speed and energy in diseased hearts, where increased inotropy does not translate into effective myocardial work. These findings highlight the potential of PSL to identify subtle energetic failure beyond standard wall motion analysis.</span></span></span></span></span></p>
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