Relation between regional and global systolic function in patients with ischemic cardiomyopathy after beta-blocker therapy or revascularization.
BACKGROUND
To assess the relationship between improved regional and global myocardial function in patients with ischemic cardiomyopathy in response to beta-blocker therapy or revascularization.


METHODS
Cardiovascular magnetic resonance (CMR) was performed in 32 patients with ischemic cardiomyopathy before and 8 +/- 2 months after therapy. Patients were assigned clinically to beta-blocker therapy (n = 20) or revascularization (n = 12). CMR at baseline was performed to assess regional and global LV function at rest and under low-dose dobutamine. Wall thickening was analyzed in dysfunctional, adjacent, and remote segments. Follow-up CMR included rest function evaluation.


RESULTS
Augmentation of wall thickening during dobutamine at baseline was similar in dysfunctional, adjacent and remote segments in both patient groups. Therefore, baseline characteristics were similar for both patient groups. In both patient groups resting LV ejection fraction and end-systolic volume improved significantly (p < 0.05) at follow-up. Stepwise multivariate analysis revealed that improvement in global LV ejection fraction in the beta-blocker treated patients was significantly related to improved function of remote myocardium (p < 0.05), whereas in the revascularized patients improved function in dysfunctional and adjacent segments was more pronounced (p < 0.05).


CONCLUSIONS
In patients with chronic ischemic LV dysfunction, beta-Blocker therapy or revascularization resulted in a similar improvement of global systolic LV function. However, after beta-blocker therapy, improved global systolic function was mainly related to improved contraction of remote myocardium, whereas after revascularization the dysfunctional and adjacent regions contributed predominantly to the improved global systolic function.
Kaandorp
T A M
TA
Department of Radiology, Leiden University Medical Center, the Netherlands. T.A.M.Kaandorp@lumc.nl
Bax
J J
JJ
Bleeker
S E
SE
Doornbos
J
J
Viergever
E P
EP
Poldermans
D
D
van der Wall
E E
EE
de Roos
A
A
Lamb
H J
HJ
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002908:Chronic Disease; D001026:Coronary Artery Bypass; D004280:Dobutamine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left / Q000187:drug effects*; D020257:Ventricular Remodeling / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D004280:Dobutamine