© 2001 European Society of Cardiology
Abnormal contractile responses during dobutamine stress echocardiography in patients with idiopathic dilated cardiomyopathy
a Department of Cardiology/Thorax Centre, University Hospital Groningen P.O. Box 30001, 9700 RB Groningen, The Netherlands
b Medical Centre Alkmaar Alkmaar, The Netherlands
* Corresponding author. Tel.: +31-50-361-2355; fax: +31-50-361-4391. E-mail address: d.j.van.veldhuisen{at}thorax.azg.nl (D.J. van Velduisen).
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Abstract |
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Background: In chronic heart failure augmented wall stress leads to increased energy demand. Supply, however, may be reduced due to coronary vasoconstriction and endothelial dysfunction. This might lead to a mismatch between demand and supply. In the present study we further explored the effect of increased demand during dobutamine stress echocardiography.
Methods and results: Sixteen patients with idiopathic dilated cardiomyopathy (mean age 44±13 years, New York Heart Association class II–III, mean left ventricular ejection fraction 0.27±0.10) underwent dobutamine stress echocardiography (5–40 µg/min per kg bodyweight+atropine if required). Wall motion and thickening was assessed in 16 segments using a four-point scale. Eleven patients (69%) showed regions with worsening of wall motion or a biphasic response during dobutamine infusion. Of the remaining five patients one patient did not show any wall motion changes and one patient showed a partial improvement while only in three patients wall motion improvement in the whole heart was found.
Conclusion: A majority of patients with idiopathic dilated cardiomyopathy showed decreased wall motion during increased demand, i.e. ischemia-like myocardial contractile responses during dobutamine stress echocardiography. These findings further support the concept that an energy mismatch between demand and supply might play a pathophysiological role in idiopathic dilated cardiomyopathy.
Key Words: Idiopathic dilated cardiomyopathy • Dobutamine stress echocardiography
Received November 3, 2000; Revised January 11, 2001; Accepted February 12, 2001
1 Dirk J. van Veldhuisen is an Established Investigator of the Netherlands Heart Foundation (Grant D97.017).
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