title: Dobutamine-induced changes of left atrial two-dimensional deformation predict clinical and neurohumoral improvement after levosimendan treatment in patients with acutely decompensated chronic heart failure.
abstract: BACKGROUND
  We investigated whether dobutamine-induced changes of the left atrial (LA) two-dimensional speckle tracking parameters are related to clinical and neurohumoral improvement after levosimendan treatment in patients with acutely decompensate chronic heart failure (ADCHF).
  
  
  METHODS
  Forty-six patients with ADCHF and LV ejection fraction <35%, were studied using dobutamine stress echocardiography before a 24-hour infusion of levosimendan. In a multivariable model, we included: dobutamine-induced LV contractile reserve, change (%) of LA volume, LV longitudinal strain rate and LA speckle tracking parameters to assess the improvement of NYHA class, 6-min walk distance and brain natriuretic peptide (BNP).
  
  
  RESULTS
  The change (%) of LA-contractile strain and LV longitudinal stain rate were independent determinants of improvement of NYHA class, and BNP and increase in the 6-min walk test distance (b=-0.59, b=-0.65, b=0.41, and b=-0.44, b=-0.40, b=0.60, respectively, p<0.05). The addition of LA-contractile strain change in the multivariable analysis including LV longitudinal stain rate change increased the value of the model from r(2)=0.46 to 0.58 for NYHA improvement and from r(2)=0.44 to 0.70, for the BNP reduction and from r(2)=0.49 to 0.60, for increase in the 6-min walk test distance (p<0.05). The change (%) of LA-reservoir strain was univariate determinant for increase in the 6-min walk test distance (b=-0.37, p=0.02) and increased the value of the multivariate model from r(2)=0.46 to 0.58, p=0.02.
  
  
  CONCLUSIONS
  In patients with ADCHF, left atrial two-dimensional speckle tracking parameters in addition to LV longitudinal strain rate may detect those patients who are prone to improve after levosimendan treatment.
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attiko University Hospital, Athens, Greece.
authors.forename: Ioannis A
authors.initials: IA
authors.lastname: Paraskevaidis
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.forename: Costantinos
authors.initials: C
authors.lastname: Papadopoulos
authors.forename: Vasilios
authors.initials: V
authors.lastname: Stassinos
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Bistola
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
mesh_terms: D000368:Aged; D016279:Atrial Function, Left / Q000187:drug effects / Q000502:physiology*; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D005544:Forecasting; D006333:Heart Failure / Q000097:blood* / Q000000981:diagnostic imaging* / Q000188:drug therapy; D006801:Humans; D006835:Hydrazones / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D018377:Neurotransmitter Agents / Q000097:blood; D011724:Pyridazines / Q000494:pharmacology / Q000627:therapeutic use*; D000077464:Simendan; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006835:Hydrazones; D018377:Neurotransmitter Agents; D011724:Pyridazines; D020097:Natriuretic Peptide, Brain; D000077464:Simendan; D004280:Dobutamine