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

Don‘t have an account?  Create new account

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