title: Dobutamine stress echocardiography for evaluating cirrhotic cardiomyopathy in liver cirrhosis.
abstract: OBJECTIVE
  The blunted ventricular systolic and diastolic contractile responses to physical and pharmacological stress in cirrhosis are termed cirrhotic cardiomyopathy (CCM). CCM has been known to involve multiple defects in the β-adrenergic signaling pathway. The aim of this study was to determine whether cirrhotic patients have blunted cardiac responses to catecholamine stimulation through dobutamine stress echocardiography (DSE).
  
  
  METHODS
  Seventy-one cirrhotic patients with normal left ventricular (LV) chamber size and ejection fraction were enrolled. The LV systolic and diastolic functions were evaluated by two-dimensional and Doppler echocardiography at rest and during peak dobutamine infusion (40 μg/kg/min). An abnormal response was defined as a decrease of less than 10% in LV end-diastolic volume, a decrease of less than 20% in end-systolic volume, and an increase of less than 10% in LV ejection fraction (EF) at peak dobutamine infusion, based on previously used criteria. The early/late diastolic flow (E/A) ratio and diastolic parameters were also measured.
  
  
  RESULTS
  A blunted LV response to dobutamine was observed in 18 of 71 cirrhotic patients (25.4%). The baseline EF was significantly higher in 18 patients with a blunted DSE response than that of those with a normal DSE response (P<0.05). The baseline and peak E/A ratios, which are common diastolic dysfunction markers, were higher in the cirrhosis group than in the control group (P<0.001). No adverse events associated with DSE were observed.
  
  
  CONCLUSIONS
  Blunted cardiac responses to dobutamine stimulation, which are implicated in defects in the β-adrenergic signaling pathway, might contribute to the pathogenesis of CCM in patients with cirrhosis.
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Moon Young
authors.initials: MY
authors.lastname: Kim
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.forename: Chan Sik
authors.initials: CS
authors.lastname: Won
authors.forename: Hong Jun
authors.initials: HJ
authors.lastname: Park
authors.forename: Hyo Keun
authors.initials: HK
authors.lastname: Jeon
authors.forename: Hyun Il
authors.initials: HI
authors.lastname: Hong
authors.forename: Jae Woo
authors.initials: JW
authors.lastname: Kim
authors.forename: Hyun Soo
authors.initials: HS
authors.lastname: Kim
authors.forename: Sang Ok
authors.initials: SO
authors.lastname: Kwon
authors.forename: Jang Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Byung Su
authors.initials: BS
authors.lastname: Yoo
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Lee
mesh_terms: D058665:Adrenergic beta-1 Receptor Agonists; D000328:Adult; D000368:Aged; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D018342:Receptors, Adrenergic, beta-1 / Q000737:chemistry / Q000378:metabolism; D012720:Severity of Illness Index; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D058665:Adrenergic beta-1 Receptor Agonists; D018342:Receptors, Adrenergic, beta-1; D004280:Dobutamine