© 2002 European Society of Cardiology
Dobutamine echocardiography in idiopathic dilated cardiomyopathy: clinical and prognostic implications
a Department of Cardiology, Ospedale Maggiore Piazza Ospedale 1, 34129 Trieste, Italy
b Department of Statistics, University of Trieste Trieste, Italy
* Corresponding author. Tel.: +39-040-3992326; fax: +39-040-761637. E-mail address: bpinamonti{at}hotmail.com
 |
Abstract |
|---|
The dobutamine echocardiographic test (DET) is frequently used in coronary artery disease to detect viable myocardium, but few data are available about its role in idiopathic dilated cardiomyopathy (IDCM). The aims of this study were to evaluate the clinical role of DET and the prognostic implications of the ‘contractile reserve’ in patients with IDCM treated with optimal medical therapy, including β-blockade (BB). A total of 51 patients with IDCM underwent DET at diagnosis. A positive response to DET (DET+) was judged to be a significant increase (
10 points) in left ventricular ejection fraction (LVEF) with a peak value 40%, and a reversed restrictive left ventricular filling pattern (RFP) if present at baseline study. Improvement at follow-up was defined according to combined clinical and echo-Doppler criteria. In all, 22 patients (43%) were classified as DET+. DET+ patients were less symptomatic (P<0.001), with lower heart rate (P<0.01), less enlarged left and right ventricles (P<0.0001 and P<0.05), higher LVEF (P=0.0001), less frequent RFP (P=0.01), and lower pulmonary pressure (P<0.01). At follow-up (34±16 months), 21 patients had improved, while four had died and seven had received a transplant. Among clinical data, NYHA classes I–II (OR=0.25, P=0.07) and BB dosage (OR=0.97, P<0.005) were significantly associated with higher transplant-free survival at multivariate analysis. The addition of DET+ (OR=0.34, P<0.05) showed a moderate but significant improvement of sensitivity, but the predictive power of the model remained low (sensitivity, 0.67; specificity, 0.55). Absence of left bundle branch block (OR=0.27, P<0.01) and BB dosage (OR=1.03, P<0.005), but not DET+, were predictive of improvement. In patients with IDCM, DET response is associated with a more favourable outcome, since it suggests an earlier stage of the disease. However, in the light of our data, the incremental prognostic power of DET response compared to clinical evaluation at enrolment, despite being significant, seems to be of limited clinical value. Further studies should be carried out in order to clarify the prognostic value of DET in IDCM patients.
Key Words: DET, dobutamine echocardiographic test • IDCM, idiopathic dilated cardiomyopathy • NYHA, New York Heart Association functional class • EF, ejection fraction • MR, mitral regurgitation • RFP, restrictive filling pattern • HF, heart failure • BB, β-blockers • LV, left ventricle • MED, metoprolol-equivalent dose
Received July 17, 2000; Revised January 23, 2001; Accepted April 26, 2001
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  L. Pratali, P. Otasevic, F. Rigo, S. Gherardi, A. Neskovic, and E. Picano The additive prognostic value of restrictive pattern and dipyridamole-induced contractile reserve in idiopathic dilated cardiomyopathy Eur J Heart Fail, August 1, 2005; 7(5): 844 - 851. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Otasevic, Z. B. Popovic, J. D. Vasiljevic, R. Vidakovic, L. Pratali, A. Vlahovic, and A. N. Nesskovic Relation of myocardial histomorphometric features and left ventricular contractile reserve assessed by high-dose dobutamine stress echocardiography in patients with idiopathic dilated cardiomyopathy Eur J Heart Fail, January 1, 2005; 7(1): 49 - 56. [Abstract] [Full Text] [PDF]
|
|