Prognostic significance of the dobutamine echocardiography test in idiopathic dilated cardiomyopathy

• Published in: The American journal of cardiology Vol. 88; no. 12; pp. 1374 - 1378
• Main Authors: Pratali, Lorenza, Picano, Eugenio, Otasevic, Petar, Vigna, Carlo, Palinkas, Attila, Cortigiani, Lauro, Dodi, Claudio, Bojic, Dragana, Varga, Albert, Csanady, Miklos, Landi, Patrizia
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15-12-2001; Elsevier; Elsevier Limited
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiomyopathy, Dilated - diagnostic imaging; Cardiomyopathy, Dilated - mortality; Cardiovascular disease; Drug therapy; Echocardiography, Stress; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Myocarditis. Cardiomyopathies; Prognosis; Prospective Studies; ROC Curve; Survival Rate; Sonography; Human; Pharmacologic test; Cardiotonic agent; Echocardiography; Prognosis; Idiopathic; Dobutamine; Cardiovascular disease; Myocardial disease; Survival; Congestive hypertrophic cardiomyopathy; Follow up study; Heart disease
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(01)02116-6

Dobutamine stress echo provides potentially useful information on idiopathic dilated cardiomyopathy (IDC). From February 1, 1997, to October 1, 1999, 186 patients (131 men and 55 women, mean age 56 ± 12 years) with IDC, ejection fraction <35%, and angiographically normal coronary arteries were studied by high-dose (up to 40 μ/kg/min) dobutamine echo in 6 centers, all quality controlled for stress echo reading. In all patients, wall motion score index (WMSI) (from 1 = normal to 4 = dyskinetic in a 16- segment model of the left ventricle) was evaluated by echo at baseline and peak dobutamine. One hundred eighty-four patients were followed up (mean 15 ± 13 months) and only cardiac death was considered as an end point. There were 29 cardiac deaths. Significant parameters for survival prediction at univariate analysis are: ΔWMSI (chi-square 20.1; p <0.0000), New York Heart Association (NYHA) class (chi-square 17.57; p <0.0000), rest ejection fraction (chi-square 10.41; p = 0.0013), angiotensin-converting enzyme inhibitors (chi-square 8.23; p = 0.0041), and hypertension (chi-square 8.08, p = 0.0045). In the multivariate stepwise analysis only ΔWMSI and NYHA were independent predictors of outcome (ΔWMSI = hazard ratio 0.02, p <0.0000; NYHA class = hazard ratio 3.83, p <0.0000). Kaplan-Meier survival estimates showed a better outcome for patients with a large inotropic response (ΔWMSI ≥0.44, a cutoff identified by receiver-operating characteristic curves analysis) than for those with a small or no myocardial inotropic response to dobutamine (93.6% vs 69.4%, p = 0.00033). Thus, in patients with IDC, an extensive contractile reserve identified by high-dose dobutamine stress echocardiography is associated with a better survival.