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- Title
Bi-ventricular contractile reserve offers an incremental prognostic value for patients with dilated cardiomyopathy.
- Authors
Kensuke Matsumoto; Hidekazu Tanaka; Akira Onishi; Yoshiki Motoji; Kazuhiro Tatsumi; Takuma Sawa; Tatsuya Miyoshi; Junichi Imanishi; Yasuhide Mochizuki; Ken-ichi Hirata
- Abstract
Aims Right ventricular (RV) as well as left ventricular (LV) function has been recognized as an important prognostic factor for heart failure patients. Our objective was thus to investigate the prognostic significance of combined assessment of bi-ventricular functional reserve for patients with dilated cardiomyopathy (DCM). Methods and results We studied 104DCMpatients with ejection fractions (EF) of 32±9%, and speckle-tracking echocardiography was used to assess both RV and LV contractile reserve under dobutamine stress (20 µg/kg/min). RV contractile function was measured as peak global longitudinal strain (GLS) from the RV free wall (RV-free), and LV function as global circumferential strain (GCS) and GLS, respectively. Event-free survival was then tracked for 17 months. Twenty-one patients (20%) developed cardiovascular events. A multivariate Cox proportional-hazards analysis revealed that the baseline EF, E/A, and the relative change in EF (ΔEF), in GCS (ΔGCS), and in RV-free (ΔRV-free) during dobutamine stress were the independent predictors of cardiovascular events (P <0.001, <0.05, <0.01, <0.05, and <0.01, respectively). A Cox model based on baseline clinical and echocardiographic variables (χ² = 23.6) was improved by the addition of LV contractile reserve parameters (plus DGCS and DEF) (χ² = 49.1; P < 0.001) and further improved by adding RV contractile reserve (plus ΔRV-free) (χ² = 60.3, P < 0.001). Conclusion Assessment of RV contractile reserve during dobutamine stress offers a significantly better prognostic value for patients with DCM. Bi-ventricular contractile reserve may be required for a favourable outcome, so that estimation of RV contractile reserve should be considered part of a comprehensive functional assessment of these patients.
- Subjects
DOBUTAMINE; LEFT heart ventricle; HEART physiology; RIGHT heart ventricle; HYPERTENSION; CARDIOVASCULAR disease diagnosis; BLOOD pressure; BLOOD pressure measurement; CARDIOLOGY; CHI-squared test; DIABETES; HEART diseases; CARDIAC patients; HEART failure; HYPERLIPIDEMIA; EVALUATION of medical care; COMORBIDITY; DATA analysis; BODY mass index; HUMAN research subjects; PROPORTIONAL hazards models; PATIENT selection; RECEIVER operating characteristic curves; BODY surface area; KAPLAN-Meier estimator; DILATED cardiomyopathy; DIAGNOSIS; THERAPEUTICS; PHYSIOLOGY
- Publication
European Heart Journal - Cardiovascular Imaging, 2015, Vol 16, Issue 11, p1213
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jev069