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Myocardial contractile reserve predicts left ventricular reverse remodeling and cardiac events in dilated
Ryota Morimoto1, Takahiro Okumura2, Akihiro Hirashiki2
1Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Insights
Dobutamine stress test (DST) can predict left ventricular reverse remodeling (LV-RR) and cardiac events in dilated cardiomyopathy (DCM) patients. A significant change in LV pressure (ΔLVdP/dtmax) indicates better outcomes.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Diagnostic Imaging
Background:
- Catecholamine sensitivity via dobutamine stress test (DST) assesses beta-adrenergic myocardial contractile reserve.
- This reserve is linked to left ventricular reverse remodeling (LV-RR).
- The study explored DST's prognostic value for LV-RR and cardiac events.
Purpose of the Study:
- To determine if DST can predict left ventricular reverse remodeling (LV-RR) in dilated cardiomyopathy (DCM) patients.
- To assess the prognostic ability of DST-derived metrics for cardiac events.
- To investigate the relationship between myocardial contractile reserve and clinical outcomes.
Main Methods:
- 192 patients with DCM (LV ejection fraction ≤45%, LV end-diastolic dimension ≥55mm) were enrolled.
- Micromanometer-based measurement of LV pressure derivative (LVdP/dtmax) was performed at baseline and during DST.
- Percentage change in LVdP/dtmax (ΔLVdP/dtmax) was calculated for 83 patients.
Main Results:
- Left ventricular reverse remodeling (LV-RR) occurred in 59% of patients over 4.7 years.
- ΔLVdP/dtmax and symptom duration independently predicted LV-RR.
- A ΔLVdP/dtmax cutoff of 75.1% predicted a lower cardiac event rate (p=0.045).
Conclusions:
- Percentage change in LV pressure during DST (ΔLVdP/dtmax) is a valuable predictor of LV-RR in DCM.
- DST-derived ΔLVdP/dtmax also predicts cardiac events in these patients.
- This non-invasive test aids in risk stratification for dilated cardiomyopathy.
Background:
Catecholamine sensitivity estimated using a dobutamine stress test (DST) is recognized as a measure of the beta-adrenergic myocardial contractile reserve, which is involved with left ventricular reverse remodeling (LV-RR). We investigated whether the prognostic ability of the DST for LV-RR could predict cardiac events.
Methods:
There was a total of 192 enrolled patients with dilated cardiomyopathy (DCM). DCM was defined as a LV ejection fraction (LV-EF) ≤45% and LV end-diastolic dimension (LVDd) ≥55mm. One hundred patients were subjected to micromanometer-based measurement of the maximal first derivative of LV pressure (LVdP/dtmax), an index of LV contractility, at baseline and following the infusion of dobutamine (10μg/kg/min) via a pigtail catheter. Percentage changes in LVdP/dtmax from the baseline to peak values under dobutamine stress (ΔLVdP/dtmax) were also calculated. After excluding 17 patients who received cardiac resynchronization therapy within 3 months of undergoing DST (n=15) and who did not receive follow-up echocardiography (n=2), 83 patients were enrolled (52.5±12.3 years).
Results:
During the follow-up period (4.7±2.6 years), LV-RR was recognized in 49 of 83 patients (59.0%). A multivariate logistic regression analysis revealed that ΔLVdP/dtmax (hazard ratio: 1.024, p=0.007) and the symptom duration (hazard ratio: 0.977, p=0.003) were independent predictors of LV-RR. A receiver operating characteristic curve analysis revealed a ΔLVdP/dtmax cut-off value of 75.1% for LV-RR and a significantly lower cardiac event rate in the ΔLVdP/dtmax≥75.1% group (p=0.045).
Conclusions:
ΔLVdP/dtmax estimated using DST was a useful predictor of LV-RR and cardiac events in patients with DCM.
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