Abstract 3761: Improvement in Left Ventricular Diastolic Filling During Low-Dose Dobutamine Predicts Functional Recovery and Reverse LV Remodeling After Revascularization in Ischemic Cardiomyopathy
Background: In patients with ischemic cardiomyopathy, left ventricular (LV) restrictive filling pattern (RF) is associated with poor long-term prognosis. However, in some patients RF can reverse to a non-RF pattern (non-RF) during low-dose dobutamine echocardiography (LDDE). We investigated whether changes in LV filling pattern during LDDE predict functional recovery and reverse LV remodeling in patients with ischemic cardiomyopathy undergoing revascularization.
Methods: Transmitral inflow was assessed by echo-Doppler at baseline and at LDDE in 52 patients with ischemic cardiomyopathy (LV ejection fraction [EF] 32±6%). After revascularization (6±2 months), LV systolic and diastolic function and LV volumes were reassessed.
Results: At rest 20 patients showed RF pattern: during LDDE it reverted to non-RF pattern in 11 (55%) patients (Rev-RF), while it persisted (P-RF) in 9 (45%). The remaining 32 patients had non-RF pattern both at rest and at LDDE (non-RF). After revascularization, EF improved much less in P-RF (1±1%) compared to both Rev-RF (12±3%, p<0.001), and to non-RF (11±7%, p<0.001). End-systolic volume index increased in P-RF group (9±22%), while it significantly decreased in Rev-RF (−40±10%, p<0.001), and in non-RF (−25±22%, p<0.001). Reversal of RF at follow up occurred in 100% Rev-RF, and only in 33% P-RF patients. At multiple logistic regression analysis, LV filling pattern during LDDE resulted more accurate than baseline filling pattern in predicting functional recovery after revascularization (p<0.01).
Conclusion: Patients with ischemic cardiomyopathy in whom LV restrictive filling pattern is seen at rest are not a homogeneous group. Reversal of diastolic dysfunction during dobutamine stress heralds improvement in systolic and diastolic function and reverse remodeling after revascularization, and it might represent a new tool to better identify the subset of patients who may benefit from revascularization.