Published Online
on November 3, 2003

A more recent version of this article appeared on November 11, 2003

This Article Full Text (PDF) All Versions of this Article: 108/19/2336    most recent 01.CIR.0000097111.00170.7Bv1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Eichhorn, E. J. Search for Related Content PubMed PubMed Citation Articles by Eichhorn, E. J. Related Collections Congestive Echocardiography Nuclear cardiology and PET

Submitted on August 19, 2002
Revised on July 30, 2003
Accepted on August 1, 2003

Myocardial Contractile Reserve by Dobutamine Stress Echocardiography Predicts Improvement in Ejection Fraction With -Blockade in Patients With Heart Failure. The -Blocker Evaluation of Survival Trial (BEST)

Eric J. Eichhorn MD^*, Paul A. Grayburn MD, Susan A. Mayer MD, Martin St John Sutton MD, Christopher Appleton MD, Jonathan Plehn MD, Jae Oh MD, Barry Greenberg MD, Anthony DeMaria MD, Robert Frantz MD, Heidi Krause-Steinrauf MS, and for the BEST Investigators

From the Department of Internal Medicine (Cardiology Division), the University of Texas Southwestern and Dallas VA Medical Centers, Dallas (E.J.E., P.A.G., S.A.M.); the University of Pennsylvania, Philadelphia (M.S.S.); the Mayo Clinic Scottsdale, Scottsdale, Ariz (C.A.); the Cardiovascular Branch of the National Institutes of Health and National Heart, Lung, and Blood Institute, Bethesda, Md (J.P.); the Mayo Clinic, Rochester, Minn (J.O., R.F.); the University of California at San Diego (B.G., A.D.); and the National Heart, Lung, and Blood Institute, Bethesda, Md, and the Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (H.K.-S.).

^* To whom correspondence should be addressed. E-mail: eeichhorn{at}csant.com.

Background---Blockers improve survival and reduce hospitalization in chronic heart failure (CHF) by biologically improving left ventricular ejection fraction (LVEF). However, a good predictor of improvement with this therapy has not been identified. This substudy of BEST examined whether myocardial contractile reserve, as determined by dobutamine stress echocardiography, predicts improvement in LVEF.

Methods and Results--Seventy-nine patients with class III/IV CHF underwent dobutamine stress echocardiography before treatment with bucindolol (n=41) or placebo (n=38). Regional wall motion score index (WMSI) was calculated as the sum of the scores in each segment divided by the total number of segments visualized. WMSI was compared with change in LVEF after 3 months of therapy as determined by gated radionuclide scan. Change in WMSI correlated inversely with change in LVEF after 3 months of bucindolol (r=-0.72, P<0.0001) and was the most significant multivariate predictor of change in LVEF (P=0.0002). Patients with contractile reserve had demographics similar to those of patients without contractile reserve, including RVEF, LVEF, systolic blood pressure, and CHF duration. However, patients without contractile reserve had higher baseline plasma norepinephrine levels (687±333 versus 420±246 pg/mL, P<0.05) and greater decrease in plasma norepinephrine in response to bucindolol (-249±171 versus -35±277 pg/mL, P<0.05).

Conclusions--This study suggests a direct relationship between contractile reserve and improvement in LVEF with -blocker therapy in patients with advanced CHF. Patients without contractile reserve have higher resting adrenergic drive, as reflected by plasma norepinephrine, and may experience greater sympatholytic effects from bucindolol.

Key words: heart failure • receptors, adrenergic, beta • bucindolol • norepinephrine • contractility

This article has been cited by other articles:

				M. Klapholz {beta}-Blocker Use for the Stages of Heart Failure Mayo Clin. Proc., August 1, 2009; 84(8): 718 - 729. [Abstract] [Full Text] [PDF]

				M. Naya, T. Tsukamoto, K. Morita, C. Katoh, K. Nishijima, H. Komatsu, S. Yamada, Y. Kuge, N. Tamaki, and H. Tsutsui Myocardial {beta}-Adrenergic Receptor Density Assessed by 11C-CGP12177 PET Predicts Improvement of Cardiac Function After Carvedilol Treatment in Patients with Idiopathic Dilated Cardiomyopathy J. Nucl. Med., February 1, 2009; 50(2): 220 - 225. [Abstract] [Full Text] [PDF]

				B. G. Svealv, M. S. Tang, F. Waagstein, and B. Andersson Pronounced improvement in systolic and diastolic ventricular long axis function after treatment with metoprolol Eur J Heart Fail, June 1, 2007; 9(6-7): 678 - 683. [Abstract] [Full Text] [PDF]

				N. Okuda, T. Ito, N. Emura, M. Suwa, T. Hayashi, H. Yoneda, and Y. Kitaura Depressed Myocardial Contractile Reserve in Patients With Obstructive Sleep Apnea Assessed by Tissue Doppler Imaging With Dobutamine Stress Echocardiography Chest, April 1, 2007; 131(4): 1082 - 1089. [Abstract] [Full Text] [PDF]