Significant prognostic impact of improvement in ventriculo-arterial coupling induced by dobutamine stress on cardiovascular outcome for patients with dilated cardiomyopathy

• Published in: European heart journal cardiovascular imaging Vol. 17; no. 11; pp. 1296 - 1304
• Main Authors: Matsumoto, Kensuke, Tanaka, Hidekazu, Ooka, Junichi, Motoji, Yoshiki, Sawa, Takuma, Mochizuki, Yasuhide, Ryo, Keiko, Tatsumi, Kazuhiro, Hirata, Ken-ichi
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-11-2016
• Subjects: Cardiomyopathy, Dilated - diagnostic imaging; Cardiomyopathy, Dilated - mortality; Cardiomyopathy, Dilated - physiopathology; Case-Control Studies; Echocardiography, Stress - methods; Echocardiography, Three-Dimensional - methods; Female; Humans; Kaplan-Meier Estimate; Male; Myocardial Contraction - drug effects; Myocardial Contraction - physiology; Observer Variation; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Assessment; ROC Curve; Statistics, Nonparametric; Stroke Volume - drug effects; Stroke Volume - physiology; Survival Analysis; Ventricular Function, Left - drug effects; Ventricular Function, Left - physiology; ventriculo-arterial coupling; dobutamine stress echocardiography; cardiac work efficiency; ventricular contractility; left ventricular energetics; dilated cardiomyopathy
• ISSN: 2047-2404; 2047-2412
• DOI: 10.1093/ehjci/jev327

Abstract
Aims
The purpose of this study was to investigate the prognostic impact of the changes in ventriculo-arterial (VA) coupling during dobutamine stress on the cardiovascular events for patients with dilated cardiomyopathy (DCM).
Methods and results
For this study, 89 DCM patients with ejection fractions of 32 ± 10% and 30 normal controls were recruited. Ees was estimated with the non-invasive single-beat method using three-dimensional echocardiography at rest and during dobutamine stress (20 μg/kg/min). Effective arterial elastance (Ea) was calculated as left ventricular (LV) end-systolic pressure divided by stroke volume, and VA coupling was calculated as Ea/Ees. Event-free survival was then tracked for 32 months. At baseline, VA coupling was far from optimal in patients with DCM compared with controls (Ea/Ees: 2.49 ± 1.02 vs. 1.04 ± 0.21, P < 0.001). During the follow-up period, 22 patients developed adverse cardiovascular events. During dobutamine stress, VA coupling was significantly improved in patients without cardiovascular events (from 2.47 ± 1.09 to 1.59 ± 0.68, P < 0.001), but remained unchanged in those with cardiovascular events. A multivariate Cox proportional-hazards analysis revealed that age, NYHA functional class (>II), and the change in VA coupling during dobutamine stress were the independent determinants of cardiovascular events (P < 0.05, <0.01, and <0.001, respectively). When patients were divided into two subgroups based on the finding of receiver operating characteristic curve analysis, patients with good VA coupling reserve (cut-off: change in VA coupling> 0.29) showed significantly favourable event-free survival than those with poor VA coupling reserve (P < 0.001).
Conclusions
Improvement in VA coupling during dobutamine stress is an important determinant of cardiovascular outcome for patients with DCM.