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Left atrial functional reserve in patients with nonischemic dilated cardiomyopathy: an echocardiographic dobutamine
Ioannis A Paraskevaidis1, Thomas Dodouras, Stamatis Adamopoulos
1Second Department of Cardiology, Onassis Cardiac Surgery Center, 356 Syngrou Avenue, 176 74 Athens, Greece. elbee@ath.forthnet.gr
Insights
Dobutamine echocardiography effectively assesses left atrial functional reserve in nonischemic dilated cardiomyopathy (DCM) patients. Improved atrial function correlated with better exercise capacity (O(2)max), indicating its clinical relevance.
Area of Science:
- Cardiology
- Cardiac Imaging
- Heart Failure Research
Background:
- Left ventricular function is often assessed using dobutamine echocardiography.
- Left atrial function plays a crucial role in overall cardiac performance.
- Nonischemic dilated cardiomyopathy (DCM) presents unique challenges in assessing cardiac reserve.
Purpose of the Study:
- To evaluate the left atrial functional reserve in patients with chronic heart failure and nonischemic DCM.
- To determine if dobutamine echocardiography can assess left atrial functional reserve.
- To correlate left atrial functional reserve with exercise capacity.
Main Methods:
- 35 patients with nonischemic DCM underwent peak oxygen consumption (O(2)max) testing.
- Low-dose dobutamine stress echocardiography was performed to assess left atrial volumes and function.
- Left atrial active emptying volume (LAEV) and fraction (LAEF) were calculated.
- Changes in LAEV and LAEF post-dobutamine stimulation represented functional reserve.
Main Results:
- Dobutamine infusion significantly increased LAEV and LAEF in the study group.
- These increases in left atrial function parameters correlated strongly with O(2)max values.
- Patients with higher O(2)max (> 14 mL/kg/min) showed improved LAEV and LAEF, while those with lower O(2)max showed a decrease.
Conclusions:
- Echocardiographic dobutamine is a viable method for evaluating left atrial functional reserve in nonischemic DCM.
- Left atrial functional reserve assessed by dobutamine correlates with exercise capacity.
- This assessment provides valuable insights into the functional status of patients with nonischemic DCM.
Objective:
To evaluate left atrial functional reserve in patients with chronic heart failure and nonischemic dilated cardiomyopathy (DCM).
Background:
Left ventricular functional status has been investigated using echocardiographic dobutamine.
Methods:
In 35 consecutive patients (29 men and 6 women; mean +/- SD age, 42.37 +/- 13.5 years), peak oxygen consumption (O(2)max) was measured; the day after, a low-dose dobutamine (5 to 10 micro g/kg/min, of 5 min each step) study was performed. Left atrial volumes at mitral valve opening, onset of left atrial systole, and mitral valve closure were measured by using two-dimensional echocardiography. Left atrial active emptying volume (LAEV) [volume at onset of atrial systole - minimal volume] was calculated, as was left atrial active emptying fraction (LAEF): [(volume at onset of atrial systole - minimal volume)/volume at onset of atrial systole] x 100. The changes (values obtained after inotropic stimulation minus those obtained at baseline) of the above-mentioned echocardiographic variables were considered as left atrial functional reserve.
Results:
In the entire study group after dobutamine infusion, increases in LAEV (3.34 +/- 7.54 mL, p = 0.01) and LAEF (6 +/- 13.2%, p = 0.01) were observed. The changes in the above-mentioned parameters were correlated with O(2)max values (r = 0.73 and r = 0.71, respectively; p < 0.001). After inotropic stimulation, LAEV and LAEF were increased in patients with O(2)max values > 14 mL/kg/min (5.62 +/- 7.28 mL and 10.04 +/- 13.13%, respectively) and decreased in patients with O(2)max values < 14 mL/kg/min (- 1.08 +/- 6.13 mL and - 1.6 +/- 9.9%, respectively; p = 0.01 for both).
Conclusion:
Echocardiographic dobutamine can evaluate left atrial functional reserve in patients with nonischemic DCM.