Prognostic significance of the dobutamine echocardiography test in idiopathic dilated cardiomyopathy

Pratali, Lorenza; Picaño, Eugenio; Otašević, Petar; Vigna, Carlo; Pálinkás, Attila; Cortigiani, Lauro; Dodi, Claudio; Bojic, Dragana; Varga, Albert; Csanády, Miklós; Landi, Patrizia

doi:10.1016/s0002-9149(01)02116-6

Cited by 93 publications

(69 citation statements)

References 18 publications

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“…Predictors of subsequent cardiac-related death: During the median follow-up of 422 days, there were 14 cardiac-related deaths (11%: 8 due to HF exacerbation, 4 ventricular arrhythmia, 2 sudden cardiac death) and 2 other deaths due to cerebral infarction. Univariate analysis was performed using the clinical parameters on admission: they showed significant differences in past hospitalization of HF, systolic blood pressure (SBP), diastolic blood pressure, TR-PG, inferior vena cava diameter at exhalation, inferior vena cava diameter at inhalation, RVDd, RVDs, RVFS, serum creatinine (Cr) levels as well as serum total bilirubin (T-Bil) levels and those using beta-blockers at dis- 48 (39) 74 (61) 107 (88) 92 (75) 27 (22) 114 (93) 6 (5) 54 (44) 62 (51) 13 (31) 29 (69) 33 (79) 28 (67) 13 (31) 37 (88) 2 (5) 14 (33) 26 (62) Values are n (%) or mean (± SD). *P value among the tertiles stratified by RVDd on admission.…”

Section: Resultsmentioning

confidence: 99%

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Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

et al. 2011

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SummaryRight ventricular (RV) dysfunction has been discussed in relation to an adverse outcome in heart failure (HF). The aim of this study was to analyze the relationship between RV function with HF exacerbation and its subsequent longterm outcome in patients with chronic left-sided HF.We studied 122 consecutive patients who were admitted for dyspnea due to exacerbated left-sided HF with a left ventricular (LV) ejection fraction of less than 40%. Conventional echocardiography was performed in the study subjects on admission and at discharge. Cox proportional hazards analysis revealed that RV end-diastolic dimension (RVDd) (hazard ratio 1.131, P = 0.005, 95% confidence interval 1.039-1.231) and the serum level of creatinine on admission were independent predictors of subsequent cardiac-related death, but RVDd at discharge and other LV parameters were not. Thus, patients were divided into tertiles on the basis of RVDd on admission: < 32 mm (n = 37), 32-40 mm (n = 43), and ≧ 40 mm (n = 42). According to the increase in the RVDd category, the cardiac-related death-free rate significantly decreased. Among the 3 groups, the pulse pressure and serum total bilirubin levels that demonstrated low cardiac output syndrome (LOS) parameters had significant differences.RVDd on admission could be measured noninvasively and easily to predict a worse long-term prognosis of chronic left-sided HF on admission, and showed correlations with LOS parameters. (Int Heart J 2011; 52: 119-126)

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Section: Resultsmentioning

confidence: 99%

“…9,[36][37][38][39][40] These conventional parameters during exercise could show a reserve of cardiac function, activity, and quality of life in patients with HF, but those at rest could not. We need to determine the responses to therapy that lead to a good prognosis in patients with DCM.…”

Section: )mentioning

confidence: 99%

Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

et al. 2011

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“…Esta última é muitas vezes utilizada como marcador de prognóstico nesta população 15 , mas é um estudo moroso que requer um treino especializado. O principal fator limitativo do estudo é a dimensão da amostra estudada que se deve à morosidade de uma avaliação funcional tão completa numa patologia pouco frequente.…”

Section: Discussionunclassified

O volume da aurícula esquerda como marcador ecocardiográfico de prognóstico em doentes com miocardiopatia dilatada

Ferreira¹,

Galrinho²,

Soares³

et al. 2013

Revista Portuguesa de Cardiologia

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Durante o seguimento, oito doentes morreram, um foi colocado em AVM e um foi transplantado. A análise de Cox univariável revelou potenciais marcadores ecocardiográficos de prognóstico na amostra tais como a dimensão da AE em modo M (HR-1,12; IC: 0,99-1,26; p = 0,067); VAE (HR-1,02; IC: 1,00-1,04; p = 0,046); VAE ajustado à superfície corporal (HR-1,03; IC: 1,00-1,07; p = 0,049); E/A (HR-0,99; IC: 0,99-1,81; p = 0,060); E/A > 2 (HR-7,00; IC:1,48-32,43; p = 0,014) e E/E' mitral (HR-1,04; IC: 1,00-1,09; p = 0,074). Na análise multivariável a única variável que permaneceu no modelo foi o VAE com o ponto de corte de 63 ml 7, IC: 0,61, p = 0,05 Objective: To evaluate the long-term prognostic value of LA volume (LAV) in patients with DCM. Methods: We prospectively studied patients admitted from January to December 2004 with a diagnosis of DCM, in sinus rhythm. Complete echocardiographic study at rest and after pharmacological stress was performed in all patients. The composite endpoint of mechanical ventricular assistance (MVA), heart transplantation or death during follow-up was assessed by univariate and multivariate analysis using a Cox regression model. Results: The study population consisted of 35 patients (68.6% male, mean age 52.0) with DCM, 82.9% of non-ischemic etiology. Ejection fraction (EF) at rest was 31.1±9.4%.During follow-up, eight patients died, one was placed on MVA and one underwent transplantation. Univariate Cox analysis showed various potential echocardiographic markers of prognosis in our population, including LA size in M-mode (HR 1.12, CI: 0.99-1.26, p=0.067), LAV (HR 1.03, CI: 1.00-1.07, p=0.046), LAV adjusted for body surface area (HR 1.03, CI: 0.99-1.26, p=0.049), E/A ratio (HR 0.99; CI: 0.99-1.81; p=0.060); E/A >2 (HR 7.00, CI: 1.48-32.43, p=0.014) and mitral E/E' ratio (HR 1.04, CI: 1.00-1.09, p=0.074).The only variable that remained in the multivariate model was LAV, with a cut-off value of 63 ml (HR 7.7, p=0.05). Conclusions: LAV was the only echocardiographic determinant of MVA, heart transplantation or death in our population with DCM. The echocardiographic parameters commonly used for risk stratification such as EF, left ventricular end-diastolic diameter and contractile reserve did not show prognostic significance in our study.

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“…Urađen je veći broj studija u kojima su kao inotropi korišćeni farmakološki agensi (dobutamin, dipiridamol) [4,5], a znatno ređe fizički napor [6]. Ove studije su pokazale da je očuvana kontraktilna rezerva udružena sa blažom formom srčane insuficijencije i/ili da identifikuje bolesnike sa boljom prognozom.…”

Section: Uvodunclassified

“…To je od značaja za pravilnu selekciju i povećani nadzor ovih pacijenata, jer je više studija pokazalo da oni imaju značajno lošiju prognozu u poređenju sa pacijentima koji imaju očuvanu kontraktilnu rezervu leve komore (4,5,6).…”

Section: Diskusijaunclassified

Differences in the clinical characteristics of patients with dilated cardiomyopathy, depending on the presence of preserved left ventricular contractile reserve assessed by exercise stress-echo-cardiography

Perić¹,

Jovanovic²,

Rašić³

et al. 2014

Praxis Med

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Očuvana kontraktilna rezerva leve komore podrazumeva sposobnost hipokinetičnih segmenata miokarda da pod dejstvom različitih inotropnih stimulusa poprave svoju kontraktilnost. Utvrditi razlike u kliničkim karakteristikama kod pacijenata sa dilatacionom kardiomiopatijom u zavisnosti od očuvane kontraktilne rezerve leve komore. U studiju je uključeno uzastopnih 55 bolesnika sa idiopatskom dilatativnom kardiomiopatijom. Svim bolesnicima uključenim u studiju urađen je stres ehokardiografski test fizičkim opterećenjem po standardnom protokolu. Postojanje očuvane kontraktilne rezerve je određivano uz pomoć promene ejekcione frakcije leve komore. Prosečna starost ispitivanih bolesnika je bila 54,98 ± 9,84 godina, 49 (89,1%) je bilo muškog pola. Na osnovu promene ejekcione frakcije leve komore kao kriterijuma kontraktilne rezerve leve komore, očuvanu kontraktilnu rezervu je imalo 25 bolesnika (45,5%). Bolesnici bez očuvane kontraktilne rezerve leve komore znatno češće u anamnezi imaju zastupljenu arterijsku hipertenziju (46,7 vs. 20,0%, p=0,038). Nema značajne razlike u zastupljenosti ostalih faktora rizika. Pacijenti sa očuvanom kontraktilnom rezervom leve komore imaju manju dimenziju leve komore na kraju sistole (49,64 ± 7,26 vs. 55,27 ± 8,36 mm, p=0.011), manji indeks volumena leve komore na kraju dijastole (77,35 ± 26,41 vs. 94,59 ± 34,97 ml/m2, p=0,005) i na kraju sistole (59,31 ± 26,05 vs. 78,62 ± 34,42 ml/m2, p=0,002), veću ejekcionu frakciju leve komore (25,48 ± 8,32 vs. 18,33 ± 6,49%, p=0,002) i niži indeks pokreta zidova leve komore (2,23 ± 0,27 vs. 2,48 ± 0,27, p=0,002). Kod bolesnika sa očuvanom kontraktilnom rezervom leve komore nalazimo manju zastupljenost arterijske hipertenzije i morfološki i funkcionalno manje oštećenu levu komoru.Ključne reči: arterijska hipertenzija, kontraktilna rezerva, dilataciona kardiomiopatija. UVODDilatativna kardiomiopatija se karakteriše proširenj-em i poremećenom sistolnom funkcijom leve ili obe srčane komore u odsustvu drugih težih bolesti. Prilikom postavljanja dijagnoze dilatacione kardiomiopatije treba pre svega isključiti postojanje značajne hipertenzije, primarne valvularne bolesti, značajne koronarne arterijske bolesti i kongenitalnih bolesti srca. Dilatacija i disfunkcija desne komore srca, kao i dijastolna disfunkcija leve komore mogu biti prisutne, ali nisu neophodne za dijagnozu dila¬tativne kardiomiopatije [1,2]. U 50% ili više bolesnika sa dilatativnom kardiomiopatijom etiološki uzrok se ne može odrediti i u tom slučaju se u kliničkoj medicini govori o idiopatskoj dilatativnoj kardiomiopatiji [3].Očuvana kontraktilna rezerva leve komore podrazumeva sposobnost hipokinetičnih segmenata miokarda da pod dejstvom različitih inotropnih stimulusa poprave svoju kontraktilnost. Urađen je veći broj studija u kojima su kao inotropi korišćeni farmakološki agensi (dobutamin, dipiridamol) [4,5], a znatno ređe fizički napor [6]. Ove studije su pokazale da je očuvana kontraktilna rezerva udružena sa blažom formom srčane insuficijencije i/ili da identifikuje bolesnike sa boljom...

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Prognostic significance of the dobutamine echocardiography test in idiopathic dilated cardiomyopathy

Cited by 93 publications

References 18 publications

Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

Prognostic Significance of Right Ventricular Dimension on Acute Decompensation in Chronic Left-Sided Heart Failure

O volume da aurícula esquerda como marcador ecocardiográfico de prognóstico em doentes com miocardiopatia dilatada

Differences in the clinical characteristics of patients with dilated cardiomyopathy, depending on the presence of preserved left ventricular contractile reserve assessed by exercise stress-echo-cardiography

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