Beta-adrenergic contractile reserve as a predictor of clinical outcome in patients with idiopathic dilated cardiomyopathy.
To examine the ability of beta-adrenergic contractile reserve assessment to predict the outcome of patients with heart failure, a prospective study was undertaken in 35 patients with idiopathic dilated cardiomyopathy and radionuclide ejection fraction below 40%. During right- and left-sided catheterization, right atrial and left ventricular (LV) pressures, peak positive LV dp/dt, cardiac index, and plasma norepinephrine and epinephrine concentrations were measured at baseline. After a left main intracoronary infusion of dobutamine (25 to 200 micrograms.min-1), beta-adrenergic contractile responsiveness was assessed as the net increase in peak positive LV dp/dt (delta LV dp/dt). After the initial examination, patients were treated with diuretics, digitalis, and angiotensin converting enzyme inhibitors and then followed-up. After a mean follow-up period of 13 +/- 7 months, two groups of patients were distinguished: those who responded to medical therapy (group A, n = 26) and those with clinical deterioration (group B, n = 9) leading to death (n = 4) or heart transplantation (n = 5). Initial peak positive LV dp/dt, LV end-diastolic pressure, cardiac index, and LV ejection fraction were better in group A than in group B (p less than 0.001). Initial plasma norepinephrine and epinephrine concentrations were significantly higher and delta LV dp/dt was lower in group B than in group A (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Dubois-Randé
J L
JL
Département de Cardiologie, Centre Hospitalo-Universitaire Henri Mondor, Créteil, France.
Merlet
P
P
Roudot
F
F
Benvenuti
C
C
Adnot
S
S
Hittinger
L
L
Duval
A M
AM
Syrota
A
A
Castaigne
A
A
Loisance
D
D
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000097:blood / Q000503:physiopathology*; D004280:Dobutamine; D004837:Epinephrine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009200:Myocardial Contraction / Q000187:drug effects; D009638:Norepinephrine / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011943:Receptors, Adrenergic, beta / Q000502:physiology*; D012044:Regression Analysis; D013318:Stroke Volume; D016277:Ventricular Function, Left
D011943:Receptors, Adrenergic, beta; D004280:Dobutamine; D009638:Norepinephrine; D004837:Epinephrine