Noninvasive assessment of left ventricular contractility by pacemaker stress echocardiography

Tonino Bombardini, Marco Agrusta, Nino Natsvlishvili, Francesco Solimene, Robert Pap, Fernando Coltorti, Albert Varga, Gaetano Mottola, Eugenio Picano

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39 Citations (Scopus)


Background: Estimating contractility of the left ventricle with noninvasive techniques is an important yet elusive goal. Positive inotropic interventions are mirrored by smaller end-systolic volumes and higher end-systolic pressures. An increased heart rate progressively increases the force of ventricular contraction (Bowditch treppe or staircase phenomenon). Aim: To assess the feasibility of a noninvasive estimation of force-frequency relation (FFR) during pacing stress in the echo lab in patients with permanent pacemaker (PM). Methods: Transthoracic stress pacing echocardiography was performed in 26 patients with a permanent pacemaker (age 69±11 years; 21 men, 5 women). Seven patients had normal function at baseline and during stress ("normals"); eight had angiographically assessed coronary artery disease (three with and five without induced ischemia with stress echo); eleven patients had dilated cardiomyopathy (DC). To build the FFR, the force was determined at different steps as the ratio of the systolic pressure (SP, cuff sphygmomanometer)/end-systolic volume index (ESV, biplane Simpson rule/body surface area). Heart rate was determined from ECG. Results: The absolute value of the FFR slope was highest in controls and lowest in DC patients. A flat-downsloping FFR was found in 12/19 patients but not for normals (p<0.01). Conclusions: Noninvasive pacemaker stress echocardiography (PASE) is a simple and efficient option to assess left ventricular (LV) contractility in patients with permanent pacemaker.

Original languageEnglish
Pages (from-to)173-181
Number of pages9
JournalEuropean journal of heart failure
Issue number2
Publication statusPublished - Mar 2 2005



  • Bowditch treppe
  • Force-frequency relationship
  • Heart failure
  • Pacemaker stress echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Bombardini, T., Agrusta, M., Natsvlishvili, N., Solimene, F., Pap, R., Coltorti, F., Varga, A., Mottola, G., & Picano, E. (2005). Noninvasive assessment of left ventricular contractility by pacemaker stress echocardiography. European journal of heart failure, 7(2), 173-181.