title: Low-dose dobutamine stress echo for reverse remodeling prediction after cardiac resynchronization.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) is a valuable option for patients with heart failure and wide QRS to reduce electromechanical dyssynchrony (DYS). High non-responders rate (30%) urges the need to improve selection of candidates for CRT. We hypothesized that low-dose dobutamine stress echocardiography (DSE) can help unmask dyssynchronous motion. The aim of this study is comparison between dyssynchrony index at rest and during low-dose dobutamine stress to predict left ventricular reverse remodeling after CRT.
  
  
  METHODS
  Prospectively, 57 consecutive patients (37 male) aged 61.8±9 who qualified for CRT according to current guidelines were enrolled. Two dimensional echocardiography and tissue Doppler imaging (TDI) were performed before and 6 month after CRT to assess reverse remodeling (rLV). Additionally DSE was performed before CRT. DYS was assessed at rest (DYSr) and peak DSE (DYSd) separately, as a difference between time to peak systolic velocity (Ts) of septum and lateral wall. Ts was corrected for heart rate.
  
  
  RESULTS
  rLV defined as decrease ≥15% of LVESV at follow-up was found in 38 (67%) patients. DYSr and DYSd were independent predictors of rLV (OR=1.04, Cl ±1.02-1.06, p<0.02 and OR=1.05, Cl±1.03-1.08, p<0.0002 respectively). ROC analysis found that DYSr>42ms and DYSd>59ms had sensitivity of 70% and 87%, specificity of 61% and 78%, and accuracy of 70% and 84% respectively for prediction of reverse remodeling LV. Area under Receiver Operating Characteristic Curve for DYSd was higher than for DYSr (0.89 vs 0.71, p<0.007).
  
  
  CONCLUSIONS
  Exercise intraventricular dyssynchrony assessed by dobutamine stress echo is a strong independent predictor of cardiac resynchronization therapy response.
authors.affiliation: 1st Department of Cardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Krystian
authors.initials: K
authors.lastname: Wita
authors.affiliation: 1st Department of Cardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Mizia-Stec
authors.affiliation: Department of Cardiology, Pomeranian Medical University, Szczecin, Poland.
authors.forename: Edyta
authors.initials: E
authors.lastname: Płońska-Gościniak
authors.affiliation: 1st Department of Cardiology, Medical University of Silesia, Katowice, Poland. Electronic address: wowr@wp.pl.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Wróbel
authors.affiliation: Department of Coronary Disease, Institute of Cardiology, Jagiellonian University, Cracow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Gackowski
authors.affiliation: 2nd Department of Cardiology, Medical University of Silesia, Katowice, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gąsior
authors.affiliation: Department of Cardiology, Medical University of Łódź, Łódź, Poland.
authors.forename: Jarosław
authors.initials: J
authors.lastname: Kasprzak
authors.affiliation: 1st Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Kukulski
authors.affiliation: 2nd Department of Cardiology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland.
authors.forename: Władysław
authors.initials: W
authors.lastname: Sinkiewicz
authors.affiliation: 2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland.
authors.forename: Celina
authors.initials: C
authors.lastname: Wojciechowska
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D004280:Dobutamine / Q000627:therapeutic use*; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies
chemical_list: D004280:Dobutamine
keywords: Dobutamine stress echocardiography; Responders for CRT; Resynchronization