Vnitr Lek 2005, 51(9):950-956

Relevance of left ventricular contractile reserve evaluated by dobutamine echocardiography in patients with advanced chronic heart failure

P. Lupínek*, P. Frídl, I. Málek, T. Marek, J. Kautzner
Klinika kardiologie IKEM, Praha, přednosta doc. MUDr. Josef Kautzner, CSc., FESC

Background:
Several publications have suggested that the examination of left ventricular contractile reserve by dobutamine echocardiography may be useful in the prognostic evaluation of patients with heart failure.

Aim:
To investigate whether the change of left ventricular volumes, ejection fraction (LVEF) and Doppler Tei index after dobutamine challenge is able to predict further evolution of heart failure.

Methods:
66 heart transplant candidates (average age 51.5 ± 9.2 years; men/women 55/11, dilated cardiomyopathy/ischemic heart disease 32/34) with chronic systolic heart failure underwent dobutamine echocardiography (5 and 10 μg/kg/min each 5 min) with assessment of enddiastolic and endsystolic volumes (EDV, ESV), LVEF and Tei index. The same parameters were examined after 1 year.

Results:
Dobutamine test showed statistically significant improvement of LVEF (p = 0.004), ESV (p = 0.003) and Tei index (p < 0.001). Changes of LVEF and Tei index with dobutamine had no relation to the changes of these parameters after 1 year. Only in patients with ischemic heart disease there was a significant correlation between EDV and ESV changes during the dobutamine test and their changes after 1 year (r = 0.61, p = 0.016; r = 0.57, p = 0,027).

Conclusions:
EDV and ESV changes during dobutamine test can predict to a certain degree left ventricular remodelling within 1 year in patients with advanced heart failure due to ischemic heart disease. Changes of LVEF and Tei index do not have such a predictive value.

Keywords: heart failure; heart transplantation; dobutamine echocardiography; left ventricular remodelling; contractile reserve

Received: November 30, 2004; Accepted: January 12, 2005; Published: September 1, 2005  Show citation

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Lupínek P, Frídl P, Málek I, Marek T, Kautzner J. Relevance of left ventricular contractile reserve evaluated by dobutamine echocardiography in patients with advanced chronic heart failure. Vnitr Lek. 2005;51(9):950-956.
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