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European Journal of Heart Failure 2008 10(5):475-481; doi:10.1016/j.ejheart.2008.03.003
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© 2008 European Society of Cardiology

NT-proBNP response to dobutamine stress echocardiography predicts left ventricular contractile reserve in dilated cardiomyopathy

Frangiskos I. Parthenakis, Alexandros P. Patrianakos, Costas N. Haritakis, Evangelos A. Zacharis, Eva G. Nyktari and Panos E. Vardas*

Department of Cardiology, Heraklion University Hospital Crete, Greece

* Corresponding author. Cardiology Department, Heraklion University Hospital, P.O. Box 1352, Stavrakia, Heraklion, Crete, Greece. Tel.: +30 2810 392706; fax: +30 2810 542055. E-mail addresses: cardio{at}med.uoc.gr (P.E. Vardas).


  Abstract

Background: Brain natriuretic peptide (BNP) and left ventricular (LV) inotropic reserve are major prognostic indexes in heart failure (HF).

Aims: To investigate the relationship between N-terminal-proBNP (NT-proBNP) changes in response to dobutamine stress echocardiography (DSE) and the LV inotropic reserve, in HF patients with dilated cardiomyopathy (DC).

Methods: We studied 41 patients with DC, LVEF 31.6±7.7%, NYHA class II–III and 15 controls. Plasma NT-proBNP levels were measured before and 60 min after three 5-min stages of dobutamine (5 to 15µg/kg/min).

Results: Based on NT-proBNP changes in response to dobutamine, patients were categorized into two groups: In Group A circulating NT-proBNP levels fell (–16.6 ± 7.8%), and in Group B they increased (8.4±9.1%). Group A had a marked improvement in WMSI compared to Group B (32.1±9.7% vs. 18.8±15.9%, p<0.001). Multivariate analysis showed that NT-proBNP changes were an independent predictor of LV inotropic reserve (b=–0.55, p<0.001). A reduction of 21.3% in plasma NT-proBNP levels in response to dobutamine predicted an improvement in WMSI of >25% with a sensitivity of 100% and a specificity of 92.3%.

Conclusions: NT-proBNP changes in response to dobutamine reflect improvement in LV contractility and constitute an independent predictor of LV inotropic reserve in patients with DC.

Key Words: Natriuretic peptides • Dobutamine • Echocardiography • Dilated cardiomyopathy

Received September 7, 2007; Revised January 28, 2008; Accepted March 6, 2008


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