Prognostic value of peak stress cardiac power in patients with normal ejection fraction undergoing exercise stress echocardiography

Vidhu Anand, Garvan C. Kane, Christopher G. Scott, Sorin V. Pislaru, Rosalyn O. Adigun, Robert B. McCully, Patricia A. Pellikka, Cristina Pislaru

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Aims: Cardiac power is a measure of cardiac performance that incorporates both pressure and flow components. Prior studies have shown that cardiac power predicts outcomes in patients with reduced left ventricular (LV) ejection fraction (EF). We sought to evaluate the prognostic significance of peak exercise cardiac power and power reserve in patients with normal EF. Methods and results: We performed a retrospective analysis in 24 885 patients (age 59 ± 13 years, 45% females) with EF ≥50% and no significant valve disease or right ventricular dysfunction, undergoing exercise stress echocardiography between 2004 and 2018. Cardiac power and power reserve (developed power with stress) were normalized to LV mass and expressed in W/100 g of LV myocardium. Endpoints at follow-up were all-cause mortality and diagnosis of heart failure (HF). Patients in the higher quartiles of power/mass (rest, peak stress, and power reserve) were younger and had higher peak blood pressure and heart rate, lower LV mass, and lower prevalence of comorbidities. During follow-up [median 3.9 (0.6-8.3) years], 929 patients died. After adjusting for age, sex, metabolic equivalents (METs) achieved, ischaemia/infarction on stress test results, medication, and comorbidities, peak stress power/mass was independently associated with mortality [adjusted hazard ratio (HR), highest vs. lowest quartile, 0.5, 95% confidence interval (CI) 0.4-0.6, P < 0.001] and HF at follow-up [adjusted HR, highest vs. lowest quartile, 0.4, 95% CI (0.3, 0.5), P < 0.001]. Power reserve showed similar results. Conclusion: The assessment of cardiac power during exercise stress echocardiography in patients with normal EF provides valuable prognostic information, in addition to stress test findings on inducible myocardial ischaemia and exercise capacity.

Original languageEnglish (US)
Pages (from-to)776-785
Number of pages10
JournalEuropean heart journal
Issue number7
StatePublished - Feb 14 2021


  • Cardiac power
  • Echocardiography
  • Exercise stress echocardiography
  • Heart failure
  • Power reserve
  • outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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