Abstract 12887: Integrated Assessment of Bi-Ventricular Contractile Reserve Under Dobutamine Stress Offers an Incremental Prognostic Value for Patients With Dilated Cardiomyopathy
Introduction: Right ventricular (RV) as well as left ventricular (LV) function, has been increasingly recognized as an important prognostic factor for heart failure patients.
Hypothesis: We assessed the hypothesis that the combined assessment of bi-ventricular functional reserve offers a significant prognostic value for patients with dilated cardiomyopathy (DCM).
Methods: One hundred and four DCM patients with ejection fractions of 32±9% were recruited, and speckle-tracking echocardiography was used to assess both RV and LV functional reserve under dobutamine stress (20 μg/kg/min). RV contractile function was measured as peak global longitudinal strain from the RV free wall (RV-free), and LV contractile function as global circumferential (GCS) and longitudinal strain (GLS). Event-free survival was then tracked for 17 months.
Results: Twenty-one patients (20%) developed adverse cardiovascular events. The Kaplan-Meier curve analysis disclosed that the patients with RV contractile reserve (relative change in RV-free: ΔS-RVfree ≥28.8%) and with LV contractile reserve (relative change in GCS: ΔGCS ≥32.9%) had a significantly better prognosis than those without (log rank p<0.001, respectively). Multivariate Cox proportional-hazards analysis revealed that ΔRV-free as well as ΔGCS were the independent predictors of cardiovascular events (p<0.001 and p<0.01, respectively). A sequential Cox model based on clinical variables (χ2 =9.2) was improved by using baseline echocardiographic parameters (χ2 =23.0; p<0.05) and LV contractile reserve parameters (plus ΔGCS) (χ2 =43.1; p<0.001) and further improved by adding ΔRV-free (χ2 =54.7, p<0.001).
Conclusions: In conclusion, assessment of RV contractile reserve during dobutamine stress offers a significantly better prognostic value for patients with DCM. Further, combined assessment of bi-ventricular functional reserve may make a major contribution to better management of these patients.
Author Disclosures: K. Matsumoto: None. H. Tanaka: None. K. Dokuni: None. Y. Hatani: None. H. Matsuzoe: None. K. Hatazawa: None. H. Toki: None. H. Shimoura: None. J. Ooka: None. H. Sano: None. T. Sawa: None. Y. Motoji: None. Y. Mochizuki: None. K. Tatsumi: None. K. Hirata: None.
- © 2014 by American Heart Association, Inc.