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Relation between regional and global systolic function in patients with ischemic cardiomyopathy after beta-blocker
T A M Kaandorp1, J J Bax, S E Bleeker
1Department of Radiology, Leiden University Medical Center, the Netherlands. T.A.M.Kaandorp@lumc.nl
Insights
Beta-blocker therapy and revascularization similarly improved global systolic function in ischemic cardiomyopathy patients. Beta-blockers improved remote myocardial function, while revascularization improved dysfunctional and adjacent segments.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Myocardial Function
Background:
- Ischemic cardiomyopathy (ICM) affects regional and global myocardial function.
- Assessing treatment effects on myocardial function is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the relationship between regional and global myocardial function improvements.
- To compare the effects of beta-blocker therapy versus revascularization in ICM patients.
Main Methods:
- Cardiovascular magnetic resonance (CMR) assessed left ventricular (LV) function at rest and during dobutamine stress.
- 32 ICM patients underwent CMR before and after treatment (beta-blockers or revascularization).
- Analysis focused on wall thickening in dysfunctional, adjacent, and remote myocardial segments.
Main Results:
- Both beta-blocker therapy and revascularization significantly improved resting LV ejection fraction and end-systolic volume.
- Beta-blocker therapy's global function improvement correlated with remote segment function.
- Revascularization's improvement was linked to dysfunctional and adjacent segments.
Conclusions:
- Both beta-blocker therapy and revascularization yield similar global systolic function improvements in ICM.
- Treatment strategy influences which myocardial regions contribute most to functional recovery.
- Understanding regional contributions can guide personalized therapy selection.
Background:
To assess the relationship between improved regional and global myocardial function in patients with ischemic cardiomyopathy in response to beta-blocker therapy or revascularization.
Materials And Methods:
Cardiovascular magnetic resonance (CMR) was performed in 32 patients with ischemic cardiomyopathy before and 8 +/- 2 months after therapy. Patients were assigned clinically to beta-blocker therapy (n = 20) or revascularization (n = 12). CMR at baseline was performed to assess regional and global LV function at rest and under low-dose dobutamine. Wall thickening was analyzed in dysfunctional, adjacent, and remote segments. Follow-up CMR included rest function evaluation.
Results:
Augmentation of wall thickening during dobutamine at baseline was similar in dysfunctional, adjacent and remote segments in both patient groups. Therefore, baseline characteristics were similar for both patient groups. In both patient groups resting LV ejection fraction and end-systolic volume improved significantly (p < 0.05) at follow-up. Stepwise multivariate analysis revealed that improvement in global LV ejection fraction in the beta-blocker treated patients was significantly related to improved function of remote myocardium (p < 0.05), whereas in the revascularized patients improved function in dysfunctional and adjacent segments was more pronounced (p < 0.05).
Conclusion:
In patients with chronic ischemic LV dysfunction, beta-Blocker therapy or revascularization resulted in a similar improvement of global systolic LV function. However, after beta-blocker therapy, improved global systolic function was mainly related to improved contraction of remote myocardium, whereas after revascularization the dysfunctional and adjacent regions contributed predominantly to the improved global systolic function.
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