© 2004 European Society of Cardiology
The additive prognostic value of restrictive pattern and dipyridamole-induced contractile reserve in idiopathic dilated cardiomyopathy
a Institute of Clinical Physiology CNR, Via G. Moruzzi no. 1, Pisa 56124, Italy
b Cardiovascular Institute Dediije and Belgrade University Medical School Belgrade, Yugoslavia
c Cardiology Division Umberto I Hospital, Mestre, Italy
d Cardiology Division Bufalini Hospital, Cesena, Italy
* Corresponding author. Tel.: +39 50 3152379; fax: +39 50 3152166. E-mail address: lorenza{at}ifc.cnr.it
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Abstract |
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Background: Diastolic dysfunction and lack of contractile reserve are unfavorable prognostic predictors in patients with dilated cardiomyopathy (DCM).
Aims: This study aims to assess whether diastolic dysfunction and lack of dipyridamole-induced contractile reserve were additive predictors of poor outcome in patients with DCM.
Methods: A total of 116 patients with DCM and ejection fraction (EF<35%) were studied by dipyridamole echo (0.84 mg/kg over 10 min). At rest, a restrictive filling pattern was defined as: E/A ratio >2 and an E-wave deceleration time of <140 ms on transmitral flow velocity profile.
Results: Rest wall motion score index (WMSI) was 2.2±0.3 and decreased to 1.9±0.41 after dipyridamole (p<0.001). During follow-up (median 26.5 months), 22 cardiac deaths occurred. At multivariate analysis, dipyridamole-induced contractile reserve yielded significant incremental prognostic value (RR=0.275, p<0.006) over NYHA class (RR=1.971, p<0.03), angiotensin-converting enzyme inhibitor therapy (RR=0.173, p<0.001), and left ventricular end-diastolic diameter (RR=1.131, p<0.001). The worst prognostic combination was the presence of restrictive pattern at rest and the absence of contractile reserve (
WMSI<0.15).
Conclusion: In patients with DCM, the ominous combination of restrictive transmitral flow pattern and lack of contractile reserve during dipyridamole stress predicts an unfavourable outcome.
Key Words: Dipyridamole echocardiography • Idiopathic dilated cardiomyopathy • Prognosis • Restrictive pattern
Received July 7, 2004; Revised August 12, 2004; Accepted October 14, 2004
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