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Inotropic contractile reserve can risk-stratify patients with HIV cardiomyopathy: a dobutamine stress

Omar Wever-Pinzon1, Sripal Bangalore, Jorge Romero

  • 1St. Luke's Roosevelt Hospital Center and Columbia University College of Physicians and Surgeons, New York, NY 10025, USA.

JACC. Cardiovascular Imaging
|December 17, 2011
PubMed

Insights

In patients with human immunodeficiency virus (HIV) cardiomyopathy, inotropic contractile reserve (ICR) assessed by dobutamine stress echocardiography (DSE) effectively predicts cardiac death and left ventricular ejection fraction (LVEF) improvement.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Echocardiography

Background:

  • HIV cardiomyopathy is a significant cause of heart failure and mortality.
  • Inotropic contractile reserve (ICR) is linked to improved outcomes in other cardiomyopathies, but its role in HIV cardiomyopathy is unclear.

Purpose of the Study:

  • To determine if ICR during dobutamine stress echocardiography (DSE) can risk-stratify patients with HIV cardiomyopathy.
  • To assess if ICR predicts improvement in left ventricular ejection fraction (LVEF) in this population.

Main Methods:

  • Sixty patients with HIV cardiomyopathy and LVEF <45% underwent DSE.
  • ICR was evaluated using the delta wall motion score index (ΔWMSI).
  • Patients were followed for cardiac death and changes in LVEF.

Main Results:

  • A ΔWMSI of 0.38 predicted cardiac death with 73% sensitivity and 88% specificity.
  • Absence of ICR and NYHA class IV were significant predictors of cardiac death.
  • A ΔWMSI of 0.59 predicted LVEF improvement with 74% sensitivity and 78% specificity; 56% of patients showed LVEF improvement, more common in those with ICR.

Conclusions:

  • ICR assessed by DSE is a valuable tool for risk stratification in HIV cardiomyopathy.
  • ICR can predict subsequent improvement in LVEF in patients with HIV cardiomyopathy.
Abstract

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