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CLINICAL STUDY: HEART FAILURE

Dobutamine echocardiographic study in patients with nonischemic dilated cardiomyopathy and prognostically borderline values of peak exercise oxygen consumption

18-month follow-up study

^a Second Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece

Manuscript received June 21, 2000; revised manuscript received December 28, 2000, accepted January 18, 2001.

Reprint requests and correspondence: Dr. Ioannis A. Paraskevaidis, Onassis Cardiac Surgery Center, 356 Sygrou Avenue, 176 74 Athens, Greece
elbee{at}ath.forthnet.gr

OBJECTIVES

We sought to study the prognostic value of dobutamine echocardiography in patients with nonischemic dilated cardiomyopathy (DCM) and prognostically borderline values of peak oxygen consumption (VO₂max) during exercise.

BACKGROUND

Changes in echocardiographic variables assessed by dobutamine echocardiography can be used to evaluate the functional status of patients with chronic heart failure (CHF) and DCM.

METHODS

In 27 consecutive patients (mean age 55 ± 15 years) with VO₂max values between 10 and 14 ml/kg body weight per min, a low infusion rate (10 µg/kg per min) dobutamine echocardiographic test was performed. The induced changes in echocardiographic variables were measured, and an 18-month follow-up study was done.

RESULTS

At the end of the protocol, 9 patients (group I) had died from cardiac reasons, whereas the remaining 18 patients (group II) survived. After dobutamine infusion, the left ventricular end-systolic diameter (LVESD) was smaller in group II (6.22 ± 0.94 cm) than in group I (6.99 ± 0.76 cm; p < 0.05), whereas end-systolic wall stress (ESWS) was higher in group I (1030.66 ± 193.98 g/cm²) than in group II (691.57 ± 297.06 g/cm²; p < 0.05). The changes in LVESD and ESWS were greater in group I (0.75 ± 0.36 cm and 463.11 ± 159.87 g/cm², respectively) than in group II (–0.04 ± 0.36 cm and 83.16 ± 291.74 g/cm², respectively; p < 0.01 for both).

CONCLUSIONS

In the "gray" zone of VO₂max, dobutamine echocardiography seems to be a valuable prognostic indicator in patients with CHF and DCM.

Abbreviations and Acronyms   CHF = chronic heart failure   DCM = dilated cardiomyopathy   ESWS = end-systolic (meridional) wall stress   FS = fractional shortening   LVEDD = left ventricular end-diastolic diameter   LVESD = left ventricular end-systolic diameter   PWTs = posterior wall thickness in systole   SBP = systolic blood pressure   Vcfc = left ventricular heart rate-corrected mean velocity of circumferential fiber shortening   VO2max = peak exercise oxygen consumption

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