title: Prognostic value of low-dose dobutamine echocardiography in patients with idiopathic dilated cardiomyopathy.
abstract: OBJECTIVE
  Dobutamine echocardiography is widely used for the evaluation of myocardial contractile reserve. The purpose of the study was to determine the prognostic value of low-dose dobutamine echocardiography in patients with idiopathic dilated cardiomyopathy (IDCM).
  
  
  METHODS
  The study group consisted of 77 consecutive patients with recently diagnosed IDCM (mean [+/- SD] age, 49 +/- 9 years; men, 82%) and left ventricular (LV) ejection fractions of < 40%.
  
  
  METHODS
  Two-dimensional and Doppler echocardiographic variables were measured before and after the infusion of dobutamine at the rate of 10 microg/kg/min for 5 min.
  
  
  RESULTS
  During a mean follow-up period of 63 +/- 7 months (range, 49 to 75 months) 30 patients (39%) died and five patients (6%) underwent successful heart transplantations. Using multivariate regression analysis, the only significant factors related to fatal outcome or the need for cardiac transplantation were the following: (1) LV end-systolic volume of > 150 mL after low-dose dobutamine infusion (odds ratio [OR], 2.2; confidence interval [CI], 1.2 to 4.1; p = 0.011); (2) no decrease of LV end-diastolic volume after dobutamine infusion (OR, 1.9; CI, 1.1 to 3.4; p = 0.031); (3) atrial fibrillation (OR, 2.7; CI, 1.4 to 5.3; p = 0.003); and (4) male gender (OR, 2.6; CI, 1.2 to 5.5; p = 0.017). A scoring system was proposed with one point assigned for each of the above-mentioned factors. The mortality rates for total scores of 0, 1, 2, 3, and 4 were 0%, 19%, 48%, 83%, and 100%, respectively.
  
  
  CONCLUSIONS
  The response of the LV to low-dose dobutamine infusion adds clinically valuable prognostic information to the evaluation of the patient with IDCM.
authors.affiliation: Department of Cardiology, Medical University of Lódź, Lódź, Poland. drozdz@ptkardio.pl
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Drozdz
authors.forename: Maria
authors.initials: M
authors.lastname: Krzemińska-Pakula
authors.forename: Michal
authors.initials: M
authors.lastname: Plewka
authors.forename: Michal
authors.initials: M
authors.lastname: Ciesielczyk
authors.forename: Jaroslaw D
authors.initials: JD
authors.lastname: Kasprzak
mesh_terms: D000328:Adult; D000368:Aged; D002306:Cardiac Volume / Q000502:physiology; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging*; D004280:Dobutamine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography / Q000187:drug effects; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects / Q000502:physiology; D011379:Prognosis; D012680:Sensitivity and Specificity; D016277:Ventricular Function, Left / Q000187:drug effects / Q000502:physiology
chemical_list: D004280:Dobutamine