Myocardial contractile reserve predicts left ventricular reverse remodeling and cardiac events in dilated cardiomyopathy.
BACKGROUND
Catecholamine sensitivity estimated using a dobutamine stress test (DST) is recognized as a measure of the beta-adrenergic myocardial contractile reserve, which is involved with left ventricular reverse remodeling (LV-RR). We investigated whether the prognostic ability of the DST for LV-RR could predict cardiac events.


METHODS
There was a total of 192 enrolled patients with dilated cardiomyopathy (DCM). DCM was defined as a LV ejection fraction (LV-EF) ≤45% and LV end-diastolic dimension (LVDd) ≥55mm. One hundred patients were subjected to micromanometer-based measurement of the maximal first derivative of LV pressure (LVdP/dtmax), an index of LV contractility, at baseline and following the infusion of dobutamine (10μg/kg/min) via a pigtail catheter. Percentage changes in LVdP/dtmaxfrom the baseline to peak values under dobutamine stress (ΔLVdP/dtmax) were also calculated. After excluding 17 patients who received cardiac resynchronization therapy within 3 months of undergoing DST (n=15) and who did not receive follow-up echocardiography (n=2), 83 patients were enrolled (52.5±12.3 years).


RESULTS
During the follow-up period (4.7±2.6 years), LV-RR was recognized in 49 of 83 patients (59.0%). A multivariate logistic regression analysis revealed that ΔLVdP/dtmax(hazard ratio: 1.024, p=0.007) and the symptom duration (hazard ratio: 0.977, p=0.003) were independent predictors of LV-RR. A receiver operating characteristic curve analysis revealed a ΔLVdP/dtmaxcut-off value of 75.1% for LV-RR and a significantly lower cardiac event rate in the ΔLVdP/dtmax≥75.1% group (p=0.045).


CONCLUSIONS
ΔLVdP/dtmaxestimated using DST was a useful predictor of LV-RR and cardiac events in patients with DCM.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: ryota.m0726@med.nagoya-u.ac.jp.
Ryota
R
Morimoto
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Takahiro
T
Okumura
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Akihiro
A
Hirashiki
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hideki
H
Ishii
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Takeo
T
Ichii
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Soichiro
S
Aoki
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Kenji
K
Furusawa
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hiroaki
H
Hiraiwa
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Toru
T
Kondo
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Naoki
N
Watanabe
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Naoaki
N
Kano
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Kenji
K
Fukaya
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Akinori
A
Sawamura
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Kyosuke
K
Takeshita
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Yasuko K
YK
Bando
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Toyoaki
T
Murohara
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D004280:Dobutamine; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011379:Prognosis; D020257:Ventricular Remodeling
D004280:Dobutamine
Dilated cardiomyopathy; Prognosis; Reverse remodeling