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Effect of Dobutamine Stress on Left Ventricular Filling in Ischemic Dilated Cardiomyopathy

Pathophysiology and Prognostic Implications

Alison M. Duncan, MRCP, PhD^_*,_*,, Eric Lim, MSc, MRCS^_*,, Derek G. Gibson, FRCP^_*, and Michael Y. Henein, MD, PhD, FACC^_*,

^_* Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
Imperial College, London, United Kingdom

View larger version (30K): [in a new window]   Figure 1 Patient with restrictive filling at rest that became non-restrictive at peak stress. Isovolumic relaxation time (IVRT) and E-wave deceleration times lengthened, E:A ratio fell, and right ventricular (RV) long-axis amplitude increased with stress. ECG = electrocardiogram; PCG = phonocardiogram.

View larger version (23K): [in a new window]   Figure 2 Patient with restrictive filling at rest that remained restrictive at peak stress. Isovolumic relaxation time (IVRT) and E-wave deceleration times shortened, E:A ratio increased, and right ventricular (RV) long axis failed to increase with stress. ECG = electrocardiogram; PCG = phonocardiogram.

View larger version (13K): [in a new window]   Figure 3 (Top) Biphasic response of isovolumic relaxation time (IVRT) and E-wave deceleration time (EDT) to stress in patients with restrictive filling at rest; IVRT and EDT both shortened with stress in all patients in group EE, whereas IVRT and EDT both lengthened with stress in all patients in group EA. (Bottom) Relationship between inotropic response and stress-induced changes in tricuspid regurgitation (TR) pressure drop; TR pressure drop decreased with stress in the majority of patients in group EA, and inotropic response (peak aortic acceleration time) was maintained, whereas TR pressure drop increased with stress in the majority of patients in group EE and the inotropic response was impaired. Group EA = restrictive filling at rest, non-restrictive at peak stress; group EE = restrictive filling at rest, remained restrictive at peak stress; PMEA = peak mitral E-wave acceleration rate.

View larger version (11K): [in a new window]   Figure 4 Kaplan-Meier survival plot. Three- and five-year survival was significantly reduced in patients with restrictive filling that remained restrictive (group EE) compared with patients with restrictive filling at rest that became non-restrictive at peak stress (group EA) and those with non-restrictive filling at rest that remained non-restrictive at peak stress (group AA).