title: Prognostic significance of the dobutamine echocardiography test in idiopathic dilated cardiomyopathy.
abstract: Dobutamine stress echo provides potentially useful information on idiopathic dilated cardiomyopathy (IDC). From February 1, 1997, to October 1, 1999, 186 patients (131 men and 55 women, mean age 56 +/- 12 years) with IDC, ejection fraction <35%, and angiographically normal coronary arteries were studied by high-dose (up to 40 micro/kg/min) dobutamine echo in 6 centers, all quality controlled for stress echo reading. In all patients, wall motion score index (WMSI) (from 1 = normal to 4 = dyskinetic in a 16- segment model of the left ventricle) was evaluated by echo at baseline and peak dobutamine. One hundred eighty-four patients were followed up (mean 15 +/- 13 months) and only cardiac death was considered as an end point. There were 29 cardiac deaths. Significant parameters for survival prediction at univariate analysis are: DeltaWMSI (chi-square 20.1; p <0.0000), New York Heart Association (NYHA) class (chi-square 17.57; p <0.0000), rest ejection fraction (chi-square 10.41; p = 0.0013), angiotensin-converting enzyme inhibitors (chi-square 8.23; p = 0.0041), and hypertension (chi-square 8.08, p = 0.0045). In the multivariate stepwise analysis only DeltaWMSI and NYHA were independent predictors of outcome (DeltaWMSI = hazard ratio 0.02, p < 0.0000; NYHA class = hazard ratio 3.83, p < 0.0000). Kaplan-Meier survival estimates showed a better outcome for patients with a large inotropic response (DeltaWMSI > or =0.44, a cutoff identified by receiver-operating characteristic curves analysis) than for those with a small or no myocardial inotropic response to dobutamine (93.6% vs 69.4%, p = 0.00033). Thus, in patients with IDC, an extensive contractile reserve identified by high-dose dobutamine stress echocardiography is associated with a better survival.
authors.affiliation: C.N.R. Institute of Clinical Physiology, Pisa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Pratali
authors.forename: E
authors.initials: E
authors.lastname: Picano
authors.forename: P
authors.initials: P
authors.lastname: Otasevic
authors.forename: C
authors.initials: C
authors.lastname: Vigna
authors.forename: A
authors.initials: A
authors.lastname: Palinkas
authors.forename: L
authors.initials: L
authors.lastname: Cortigiani
authors.forename: C
authors.initials: C
authors.lastname: Dodi
authors.forename: D
authors.initials: D
authors.lastname: Bojic
authors.forename: A
authors.initials: A
authors.lastname: Varga
authors.forename: M
authors.initials: M
authors.lastname: Csanady
authors.forename: P
authors.initials: P
authors.lastname: Landi
mesh_terms: D000368:Aged; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging* / Q000401:mortality; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015996:Survival Rate