Contractile reserve induced with dobutamine echocardiography predicts outcome in patients with left ventricular
Insights
Contractile reserve (CR) in patients with mitral regurgitation (MR) and left ventricular dysfunction (LVD) predicts better outcomes. Dobutamine stress echocardiography (DSE) identified CR, significantly reducing the risk of death or heart transplantation.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Management
Background:
- Management of mitral regurgitation (MR) with left ventricular dysfunction (LVD) remains controversial.
- Assessing contractile reserve (CR) may aid in risk stratification for these patients.
Purpose of the Study:
- To determine if CR, assessed by dobutamine stress echocardiography (DSE), is associated with improved outcomes in patients with MR and LVD.
- Investigate the prognostic value of CR in this patient population.
Main Methods:
- 125 patients with LVEF ≤ 35% and significant MR underwent DSE.
- CR was defined as a > 10% increase in LVEF during dobutamine infusion.
- Primary outcomes were death and heart transplantation.
Main Results:
- 43% of patients demonstrated CR.
- CR was associated with a significantly lower rate of death or heart transplantation within five years (12.7% vs. 34.3%, p < 0.01).
- CR independently predicted reduced mortality and need for transplantation, even after adjusting for clinical factors.
Conclusions:
- In patients with advanced LVD and severe MR, CR detected by DSE is a significant predictor of improved survival.
- DSE-derived CR can inform clinical decision-making for patients with complex heart conditions.
Background And Aim Of The Study:
The appropriate management of patients with mitral regurgitation (MR) and left ventricular dysfunction (LVD) is controversial. The study aim was to determine whether the presence of contractile reserve (CR) assessed by dobutamine stress echocardiography (DSE) was associated with improved outcomes.
Methods:
Death and heart transplantation were analyzed as the primary outcomes associated with the presence of CR. A total of 125 consecutive patients (96 males, 29 females; mean age 60 +/- 12 years) with left ventricular ejection fraction (LVEF) < or = 35% and hemodynamically significant MR underwent DSE between 1999 and 2005. CR was defined as an increase in LVEF of > or = 10% during dobutamine infusion.
Results:
Among 125 patients, 55 (43.0%) showed evidence of CR. Within five years after DSE, 24 patients (34.3%) in the CR- group and seven (12.7%) in the CR+ group had died or required heart transplantation (p < 0.01, log rank). After adjusting for age, baseline LVEF, NYHA class and moderate/severe tricuspid regurgitation (TR), CR remained an independent predictor of time to death or heart transplantation (HR 0.34; 95% CI: 0.15-0.76, p < 0.01). Improvement in the degree of MR was present at one year in 85.0% of CR+ patients, and in 62.5% of CR- patients (p = 0.03). An improvement of 5% in LVEF was noted in the CR+ group, compared to 0% in the CR- group (p = 0.04).
Conclusion:
In patients with advanced LVD and severe MR, CR detected by DSE was associated with significant reductions in the risk of death and heart transplantation.
More Related Videos
Related Concept Videos
Mitral Regurgitation I: Introduction
Mitral Regurgitation II: Clinical Features and Diagnostic Tests
Mitral Stenosis II: Clinical features and Diagnostic Tests
Mitral Regurgitation III: Medical Management
Mitral Regurgitation IV: Nursing Management
Cardiomyopathy II: Dilated Cardiomyopathy


