title: Tissue Doppler systolic velocity change during dobutamine stress echocardiography predicts contractile reserve and exercise tolerance in patients with heart failure.
abstract: OBJECTIVE
  Dobutamine stress echocardiography (DSE) is widely used to evaluate myocardial contractile reserve in patients with heart failure (HF). The aim of the study was to assess the relationship between the tissue Doppler (TD) mitral annulus systolic velocity (Sm) change during DSE, contractile reserve, and aerobic exercise capacity in HF patients.
  
  
  RESULTS
  Sixty-four HF patients (age 67 ± 9 years, 58% with an ischaemic aetiology, and a mean value of the ejection fraction 29 ± 7%) underwent high-dose DSE. The mean value of the TD mitral annulus septal-lateral Sm change was analysed at rest and at peak DSE. All patients underwent also the cardiopulmonary exercise test. With a receiver operating characteristic analysis, a value of 2.02 cm/s obtained as a stress-rest difference in a mean value of the peak systolic velocity of the mitral annulus (Sm) was the best value for diagnosing the myocardial contractile reserve [area under the curve 0.69 (95% CI 0.56-0.80), sensitivity 69% (95% CI 54-81), specificity 80% (95% CI 45-97)]. The patient population was divided into two groups: with rest-stress Sm change during DSE ≤ 2.02 cm/s and with rest-stress Sm change >2.02 cm/s. Patients with Sm rest-stress >2.02 change during DSE, compared with patients with rest-stress change ≤2.02, showed a lower incidence of severe diastolic dysfunction at rest (16 vs. 46%, P= 0.039) and lower E/Ea values (11 ± 5 vs. 15 ± 6, P = 0.005), similar ejection fraction at rest but higher ejection fraction at peak DSE (53 ± 14 vs. 41 ± 12%, P = 0.001), better myocardial contractile reserve assessed by a pressure-volume relationship (1.89 ± 2.01 vs. 0.58 ± 1.38 mmHg/mL/m(2), P = 0.004), with a lower end-systolic volume (-46 ± 20 vs. -24 ± 19%, P< 0.001), a higher increase in the ejection fraction (23 ± 10 vs. 12 ± 10%, P = 0.001) during DSE, and better peak oxygen consumption (16 ± 4 vs. 13 ± 2 mL/kg/min, P = 0.01).
  
  
  CONCLUSIONS
  In patients with HF, the rest-stress variation of mitral annulus systolic velocities during DSE predicts the presence of myocardial contractile reserve and exercise tolerance.
authors.affiliation: Division of Cardiology, Fatebenefratelli Hospital, Viale Principe di Napoli, 12, Benevento I-82100, Italy. qciampi@iol.it
authors.forename: Quirino
authors.initials: Q
authors.lastname: Ciampi
authors.forename: Lorenza
authors.initials: L
authors.lastname: Pratali
authors.forename: Michele Della
authors.initials: MD
authors.lastname: Porta
authors.forename: Bruno
authors.initials: B
authors.lastname: Petruzziello
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Manganiello
authors.forename: Bruno
authors.initials: B
authors.lastname: Villari
authors.forename: Eugenio
authors.initials: E
authors.lastname: Picano
authors.forename: Rosa
authors.initials: R
authors.lastname: Sicari
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015150:Echocardiography, Doppler / Q000379:methods; D025401:Echocardiography, Stress; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D054143:Heart Failure, Systolic / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D015588:Observer Variation; D010101:Oxygen Consumption / Q000502:physiology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D013599:Systole / Q000187:drug effects / Q000502:physiology