Abstract 367: Dobutamine Stress Echocardiography Predicts Improvement of Left Ventricular Function in Patients With Human Immunodeficiency Virus Induced Cardiomyopathy
Background: Dobutamine stress echocardiography (DSE) is useful for distinguishing hibernating and/or stunned myocardium from scar in ischemic and nonischemic cardiomyopathy, thus it can identify a subset of patients whose left ventricular ejection fraction (LVEF) will improve following appropriate therapy. However, the predictive value of inotropic contractile reserve (ICR) during DSE, in patients with HIV cardiomyopathy is not known.
Methods: Thirty-five patients (68% men, mean age 54±10 years) with HIV and LV dysfunction (mean EF 27.8±11%) underwent DSE. A follow up echocardiogram was performed to evaluate LVEF. ICR was evaluated by the change in wall motion score index (ΔWMSI), calculated as the difference in WMSI from baseline to low and peak dose DSE; and the number of recruiting LV segments.
Results: All 35 patients had a follow up echocardiogram after 2.3±1.9 years. In 48% of the patients, the LVEF improved from baseline (27±9%) to 46±10% at follow up (p=0.04). Of the 560 LV segments, 67% showed recruitment during DSE. ICR determined by ΔWMSI and number of recruiting segments correlates well with improvement in LVEF (ΔWMSI r=0.4, LV segments r=0.4). The ÄWMSI was significantly higher in the group who had improvement in LVEF (−1.1±0.53 vs −0.67±0.54; p=0.028), compared to those without improvement. The number of recruiting segments was also higher in the group who had improvement in LVEF (13.6±3.8 vs 8.8±4.5; p=0.002). A ÄWMSI of −0.91 gives a specificity of 78% and sensitivity of 71% to predict LVEF improvement in patients with HIV cardiomyopathy on medical therapy (Figure⇓).
Conclusion: ICR during DSE can predict improvement of LVEF in patients with HIV cardiomyopathy.