#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Relevance of left ventricular contractile reserve evaluated by dobutamine echocardiography in patients with advanced chronic heart failure


Authors: P. Lupínek;  P. Frídl;  I. Málek;  T. Marek;  J. Kautzner
Authors‘ workplace: Klinika kardiologie IKEM, Praha, přednosta doc. MUDr. Josef Kautzner, CSc., FESC
Published in: Vnitř Lék 2005; 51(9): 950-956
Category: Original Contributions

Overview

Background:
Several publications have suggested that the examination of left ventricular contractile reserve by dobutamine echocardiography may be useful in the prognostic evaluation of patients with heart failure.

Aim:
To investigate whether the change of left ventricular volumes, ejection fraction (LVEF) and Doppler Tei index after dobutamine challenge is able to predict further evolution of heart failure.

Methods:
66 heart transplant candidates (average age 51.5 ± 9.2 years; men/women 55/11, dilated cardiomyopathy/ischemic heart disease 32/34) with chronic systolic heart failure underwent dobutamine echocardiography (5 and 10 µg/kg/min each 5 min) with assessment of enddiastolic and endsystolic volumes (EDV, ESV), LVEF and Tei index. The same parameters were examined after 1 year.

Results:
Dobutamine test showed statistically significant improvement of LVEF (p = 0.004), ESV (p = 0.003) and Tei index (p < 0.001). Changes of LVEF and Tei index with dobutamine had no relation to the changes of these parameters after 1 year. Only in patients with ischemic heart disease there was a significant correlation between EDV and ESV changes during the dobutamine test and their changes after 1 year (r = 0.61, p = 0.016; r = 0.57, p = 0,027).

Conclusions:
EDV and ESV changes during dobutamine test can predict to a certain degree left ventricular remodelling within 1 year in patients with advanced heart failure due to ischemic heart disease. Changes of LVEF and Tei index do not have such a predictive value.

Key words:
heart failure - heart transplantation - dobutamine echocardiography - left ventricular remodelling - contractile reserve


Sources

1. Broberg CS, Pantely GA, Barber BJ et al. Validation of the myocardial performance index by echocardiography in mice: a noninvasive measure of left ventricular function. J Am Soc Echocardiogr 2003; 16: 814-823.

2. Dubois-Randé JL, Merlet P, Roudot F et al. β-adrenergic contractile reserve as a predictor of clinical outcome in patients with idiopatic dilated cardiomyopathy. Am Heart J 1992; 124: 679-685.

3. Dujardin KS, Tei C, Yeo TC et al. Prognostic value of a Doppler index combining systolic and diastolic performance in idiopathic dilated cardiomyopathy. Am J Cardiol 1998; 82: 1071-1076.

4. Duncan AM, Francis DP, Henein MY et al. Importance of left ventricular activation in determining myocardial performance (Tei) index: comparison with total isovolumic time. International Journal of Cardiology 2004; 95: 211-217.

5. Duncan AM, Francis DP, Henein MY et al. Limitation of cardiac output by total isovolumic time during pharmacologic stress in patients with dilated cardiomyopathy. J Am Coll Cardiol 2003; 41: 121-128.

6. Eichhorn EJ, Grayburn PA, Mayer SA et al. Myocardial contractile reserve by dobutamine stress echocardiography predicts improvement in ejection fraction with β-blockade in patients with heart failure. The β-Blocker Evaluation of Survival Trial (BEST). Circulation 2003; 108: 2336-2341.

7. Harjai KJ, Scott L, Vivekananthan K et al. The Tei index: a new prognostic index for patients with symptomatic heart failure. J Am Soc Echocardiogr 2002; 15: 864-868.

8. Kitaoka H, Takata J, Yabe T et al. Low dose dobutamine stress echocardiography predicts the improvement of left ventricular systolic function in dilated cardiomyopathy. Heart 1999; 81: 523-527.

9. Koga S, Ikeda S, Matsunaga K. Influence of hemodialysis on echocardiographic Doppler indices left ventricle: changes in parameters of systolic and diastolic function and Tei index. Clinical Nephrology 2003; 59: 180-185.

10. Kuniyosi T, Kazuyuki K, Shirotani T et al. The prognosis of heart failure and Tei’s doppler index change during dobutamine echocardiogram. Journal of Cardiac Failure 1999; 5(Suppl 2): P20.

11. Lupínek P, Frídl P, Málek I. Kombinovaný dopplerovský index a jeho význam pro posouzení funkce levé komory při pokročilém srdečním selhání. Cor Vasa 2000; 42(Suppl 4): 45.

12. Marmor A, Schneeweiss A. Prognostic value of noninvasively obtained left ventricular contractile reserve in patients with severe heart failure. J Am Coll Cardiol 1997; 29: 422-428.

13. Meluzín J. Poznámka k článku “Index myokardiální funkce” autorů Nehyba S, Elbl L, Chaloupka V. Kardiol Rev 2000; 2(3): 52.

14. Moller JE, Poulsen SH, Egstrup K. Effect of preload alternations on a new Doppler echocardiographic index of combined systolic and diastolic performance. J Am Soc Echocardiogr 1999; 135: 1065-1072.

15. Moller JE, Sondergaard E, Poulsen SH et al. The Doppler echocardiographic myocardial performance index predicts left-ventricular dilation and cardiac death after myocardial infarction. Cardiology 2001; 95: 105-111.

16. Naqvi TZ, Goel RK, Forrester JS et al. Myocardial contractile reserve on dobutamine echocardiography predicts late spontaneous improvement in cardiac function in patients with recent onset idiopathic dilated cardiomyopathy. J Am Coll Cardiol 1999; 34: 1537-1544.

17. Navazio A, Catellani E, Montanari P et al. Prognostic value of Doppler derived index of combined systolic/diastolic myocardial performance in patients with heart failure and reduced left ventricular ejection fraction. Eur Heart J 2000; 21(Suppl): P1831.

18. Nehyba S, Elbl L, Chaloupka V. Index myokardiální funkce. Kardiologická revue 2000; 2(3): 35-39.

19. Norager B, Husic M, Moller J et al. The Doppler Tei index during dobutamine stress echocardiography: A powerful predictor of mortality after acute myocardial infarction. J Am Coll Cardiol 2004; 43(Suppl 2): 331A.

20. Paraskevaidis IA, Adamopoulos S, Kremastinos DT. Dobutamine echocardiographic study in patients with nonischemic dilated cardiomyopathy and prognostically borderline values of peak exercise oxygen consumption. J Am Coll Cardiol 2001; 37: 1685-1691.

21. Ramahi TM, Longo MD, Cadariu AR et al. Left ventricular inotropic reserve and right ventricular function predict increase of left ventricular ejection fraction after beta-blocker therapy in nonischemic cardiomyopathy. J Am Coll Cardiol 2001; 37: 818-824.

22. Scrutinio D, Napoli V, Passantino A et al. Low-dose dobutamine responsiveness in idiopathic dilated cardiomyopathy: relation to exercise capacity and clinical outcome. Eur Heart J 2000; 21: 927-934.

23. Szymański P, Rezler J, Stec S et al. Long term prognostic value of a combined index of systolic/diastolic myocardial performance in myocardial infarction. J Am Coll Cardiol 1999; 33(Suppl 1): 430A.

24. Tan LB. Cardiac pumping capability and prognosis in heart failure. Lancet 1986; 2: 1360-1363.

25. Tei C, Dujardin KS, Hodge DO et al. Doppler index combining systolic and diastolic myocardial performance: Clinical value in cardiac amyloidosis. J Am Coll Cardiol 1996; 28: 658-664.

26. Tei C, Ling LH, Hodge DO et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function - a study in normals and dilated cardiomyopathy. J Cardiol 1995; 26: 357-366.

27. Widimský J. Epidemiologie srdečního selhání. In: Widimský J et al. Srdeční selhání. Praha: Triton 2003.

Labels
Diabetology Endocrinology Internal medicine
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#