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Relation between left ventricular contractile reserve during low dose dobutamine echocardiography and plasma
A F L Schinkel1, E C Vourvouri, J J Bax
1Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Rotterdam, Netherlands.
Insights
In ischemic cardiomyopathy, higher natriuretic peptide levels indicate poor prognosis. However, preserved contractile reserve is linked to lower atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels, suggesting a better outlook.
Area of Science:
- Cardiology
- Biochemistry
- Medical Diagnostics
Background:
- Raised plasma natriuretic peptides correlate with poor prognosis in ischemic cardiomyopathy.
- Contractile reserve is a positive prognostic indicator in ischemic cardiomyopathy.
Purpose of the Study:
- To investigate the relationship between plasma natriuretic peptide levels and myocardial contractile reserve in patients with ischemic cardiomyopathy.
Main Methods:
- Prospective observational study involving 66 patients undergoing dobutamine stress echocardiography.
- Patients were divided into two groups: those with ischemic cardiomyopathy and heart failure symptoms, and those with normal left ventricular function.
- Plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) were measured.
Main Results:
- Patients with ischemic cardiomyopathy had significantly higher plasma ANP and BNP levels compared to controls.
- In patients with ischemic cardiomyopathy, the presence of contractile reserve was inversely associated with ANP and BNP concentrations.
- Individuals with contractile reserve exhibited lower ANP and BNP levels than those without.
Conclusions:
- Plasma natriuretic peptide levels are elevated in patients with left ventricular dysfunction.
- Preserved myocardial contractile reserve is associated with relatively lower levels of ANP and BNP, indicating a potentially more favorable prognosis.
Background:
In ischaemic cardiomyopathy, raised plasma concentrations of natriuretic peptides are associated with a poor long term prognosis, while the presence of contractile reserve is a favourable sign.
Objective:
To assess the relation between plasma natriuretic peptides and contractile reserve.
Design:
Prospective observational study.
Setting:
Tertiary referral centre.
Patients:
66 consecutive patients undergoing low dose dobutamine stress echocardiography to evaluate contractile reserve in regions with contractile dysfunction at rest, divided into two groups: group 1, 31 patients with ischaemic cardiomyopathy (left ventricular ejection fraction < or = 40%) and heart failure symptoms; group 2, 35 patients with normal left ventricular function.
Main Outcome Measures:
Plasma atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), measured using immunoradiometric assays. Contractile reserve was defined as an improvement in segmental wall motion score during infusion of low dose dobutamine.
Results:
Plasma ANP and BNP concentrations were higher in group 1 than in group 2 (mean (SD): ANP, 17.8 (32.8) v 7.2 (9.7), p < 0.005; BNP, 24.4 (69.0) v 5.0 (14.3) pmol/l, respectively; p < 0.001). In group 1, the presence of contractile reserve was inversely related to ANP and BNP levels; however, patients with contractile reserve had lower ANP and BNP concentrations than patients without contractile reserve (ANP, 14.2 (9.1) v 24.2 (44.2), p < 0.05; BNP, 20.2 (25.5) v 37.5 (93.8) pmol/l, respectively; p < 0.05).
Conclusions:
Plasma natriuretic peptide concentrations are raised in patients with left ventricular dysfunction, but in the presence of preserved myocardial contractile reserve, relatively low levels of ANP and BNP are present.
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