Low-dose dobutamine test associated with interventricular dyssynchrony: A useful tool to identify cardiac resynchronization therapy responders

Gasparini, Maurizio; Muto, Carmine; Iacopino, Saverio; Zanon, Francesco; Dicandia, Cosimo; Distefano, Giuseppe; Favale, Stefano; Neja, Carlo Peraldo; Bragato, Renato; Davinelli, Mario; Mangoni, Lorenza; Denaro, Alessandra

doi:10.1016/j.ahj.2011.11.015

Cited by 24 publications

(25 citation statements)

References 39 publications

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“…Inconsistent results have been obtained with several echocardiographic indices of left ventricular dyssynchrony [23]. The presence of myocardial contractile reserve assessed during SE predicted the response to cardiac resynchronization therapy: the use of SE had obvious potential for a better selection of cardiac resynchronization therapy candidates, in whom a preserved contractility is related to a higher percentage of clinical and echocardiographic responders to cardiac resynchronization therapy [24–27]. …”

Section: Methodsmentioning

confidence: 99%

Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease

Picaño

Ciampi

Citro

et al. 2017

Cardiovasc Ultrasound

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BackgroundStress echocardiography (SE) has an established role in evidence-based guidelines, but recently its breadth and variety of applications have extended well beyond coronary artery disease (CAD). We lack a prospective research study of SE applications, in and beyond CAD, also considering a variety of signs in addition to regional wall motion abnormalities.MethodsIn a prospective, multicenter, international, observational study design, > 100 certified high-volume SE labs (initially from Italy, Brazil, Hungary, and Serbia) will be networked with an organized system of clinical, laboratory and imaging data collection at the time of physical or pharmacological SE, with structured follow-up information. The study is endorsed by the Italian Society of Cardiovascular Echography and organized in 10 subprojects focusing on: contractile reserve for prediction of cardiac resynchronization or medical therapy response; stress B-lines in heart failure; hypertrophic cardiomyopathy; heart failure with preserved ejection fraction; mitral regurgitation after either transcatheter or surgical aortic valve replacement; outdoor SE in extreme physiology; right ventricular contractile reserve in repaired Tetralogy of Fallot; suspected or initial pulmonary arterial hypertension; coronary flow velocity, left ventricular elastance reserve and B-lines in known or suspected CAD; identification of subclinical familial disease in genotype-positive, phenotype- negative healthy relatives of inherited disease (such as hypertrophic cardiomyopathy).ResultsWe expect to recruit about 10,000 patients over a 5-year period (2016-2020), with sample sizes ranging from 5,000 for coronary flow velocity/ left ventricular elastance/ B-lines in CAD to around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of Fallot. This data-base will allow to investigate technical questions such as feasibility and reproducibility of various SE parameters and to assess their prognostic value in different clinical scenarios.ConclusionsThe study will create the cultural, informatic and scientific infrastructure connecting high-volume, accredited SE labs, sharing common criteria of indication, execution, reporting and image storage of SE to obtain original safety, feasibility, and outcome data in evidence-poor diagnostic fields, also outside the established core application of SE in CAD based on regional wall motion abnormalities. The study will standardize procedures, validate emerging signs, and integrate the new information with established knowledge, helping to build a next-generation SE lab without inner walls.

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Section: Methodsmentioning

confidence: 99%

Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease

Picaño

Ciampi

Citro

et al. 2017

Cardiovasc Ultrasound

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“…Controversy, however, exists about the capacity of the inotropic challenge to predict a long-term clinical response. A multicenter, prospective, observational study of left ventricular (LV) contractile reserve, as assessed using low-dose dobutamine infusion, was unable to demonstrate a significant difference in cardiac survival between patients who did or did not achieve an absolute increase in LV ejection fraction > 5 points during the drug infusion [3]. Only the combination of cardiac survival and/or heart failure hospitalization as a clinical end-point demonstrated a significant association with the inotropic challenge [3].…”

Section: Introductionmentioning

confidence: 99%

Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization

Vecchi

Facchini

Degiovanni

et al. 2016

IJC Heart & Vasculature

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BackgroundIt has been reported that contractility, as assessed using dobutamine infusion, is independently associated with reverse remodeling after CRT. Controversy, however, exists about the capacity of this approach to predict a long-term clinical response. This study's purpose was to assess whether long-term CRT clinical effects can be predicted according to acute inotropic response induced by biventricular stimulation (CRT on), as compared with AAI–VVI right stimulation pacing mode (CRT off), quantified at the time of implantation.MethodsIn 98 patients (ejection fraction 29 ± 10%), acute changes in left ventricular (LV) elastance (Ees), arterial elastance (Ea), and Ees/Ea, as assessed from slope changes of the force–frequency relation obtained when the heart rate increased, and also assessed while measuring triplane LV volumes and continuous noninvasive blood pressure, were related to death or rehospitalization during a 3-year follow-up. Other covariances tested were age, gender, disease etiology, QRS duration, amount of mitral regurgitation, LV diastolic volume, ejection fraction, and the degree of asynchrony and longitudinal strain at baseline.ResultsThere was a marked increment in the Ees slope with CRT (interaction P = 0.004), no Ea change, and modest Ees/Ea increase (interaction P < 0.05). In Cox analysis, however, neither slope changes nor baseline values of Ees, Ea, and Ees/Ea were associated with long-term follow-up. Only ventricular diastolic volume (direct relation P = 0.002) and QRS duration (inverse relation P = 0.009) predicted death/rehospitalization.ConclusionsAcute contractile recovery in CRT patients is not associated with 3 years prognosis. Instead, death or rehospitalization can be predicted from QRS duration and LV diastolic volume at baseline.

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“…after CRT implantation Myocardial viability and contractile reserve belong to the determinants of CRT effectiveness in both ischaemic and non-ischaemic cardiomyopathy [11][12][13][14]. Lim et al [11] used LDSE to assess contractile reserve, and demonstrated that contractile reserve preserved in the paced LV region correlates with an acute haemodynamic response and the LV reverse remodelling six months after CRT.…”

Section: Inotropic Contractile Reserve and Fmrimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Myocardial viability can be examined with several validated techniques, applied in ischaemic and non-ischaemic cardiomyopathy. Contractile reserve assessed by means of a widely available low-dose dobutamine stress-echo (LDSE) has high sensitivity and specificity [11][12][13][14].Little is known about the predictors of FMRI after CRT implantation in short-term observation. While the role of preserved contractile reserve as a predictor of post-CRT clinical improvement and the LV reverse remodelling is well documented, its predictive value with regards to FMRI is unclear.…”

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confidence: 99%

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Predictors of functional mitral regurgitation improvement during a short-term follow-up after cardiac resynchronisation therapy

Brzezińska¹,

Łoboz‐Grudzień

Wita

et al. 2016

Kardiol Pol

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A b s t r a c t Background and aim:The study was undertaken to assess the predictive role of myocardial contractile reserve for functional mitral regurgitation (FMR) improvement after cardiac resynchronisation therapy (CRT), and to define other predictors of FMR improvement (FMRI) and the impact of FMRI on left ventricular (LV) reverse remodelling. Methods and results:Among 90 patients in whom echocardiography was performed one day before and six weeks after CRT implantation, 66 with at least FMR(2+) in a four-point scale (mean age 64 ± 10 years, mean LV ejection fraction [LVEF] 25.7 ± 6%, ischaemic aetiology 48%) were included. FMRI was defined as the reduction of the FMR severity by at least one grade. The patients were divided into groups: A with FMRI (n = 30) and B without FMRI (n = 36). Contractile reserve was evaluated using low-dose dobutamine stress-echo before CRT implantation and was defined as a relative improvement in LVEF of more than 20% and segmental contractility improvement. Reverse remodelling was defined as the reduction of the LV end-systolic volume (LVESV) by at least 15%. Cox regression multivariate analysis revealed the following predictors for FMRI: contractile reserve preserved in more than three segments with an OR = 5.7 (95% CI 1.81-17.97, p = 0.005, sensitivity 65.5%, specificity 72.2%, AUC = 0.727) and LV end-diastolic diameter ≤ 74 mm with an OR = 2.09 (95% CI 0.75-5.78, p < 0.05, sensitivity 80.0%, specificity 47.2%, AUC = 0.632). FMRI was associated with greater reduction of LVESV (p = 0.002), greater increase in LVEF (p < 0.001) and higher incidence of the LV reverse remodelling (p < 0.001). Conclusions:Preserved contractile reserve and lesser degree of LV dilation were predictive factors of short-term FMR improvement after CRT implantation. FMR improvement was associated with higher incidence of the LV reverse remodelling early, already in the six weeks after CRT implantation. 666INTRODUCTION Cardiac resynchronisation therapy (CRT) is an established treatment option for patients with advanced chronic heart failure and prolonged QRS duration. The outcome of CRT is determined by a number of factors, and the improvement of functional mitral regurgitation (FMR) is one of the mechanisms behind the beneficial effect of the treatment [1, 2].Significant FMR has important prognostic implications and is associated with a relatively high morbidity and mortality [3]. FMR caused by dilation, altered geometry, and systolic dysfunction of the left ventricle (LV) can itself promote progressive remodelling in the course of ischaemic or non-ischaemic dilated cardiomyopathy [4,5]. This results in a vicious circle, with both LV dilatation and FMR acting as self-perpetuating processes. CRT may contribute to the reduction of FMR and reversing LV dilation [6,7].Functional mitral regurgitation, observed in patients with ischaemic and non-ischaemic cardiomyopathy, results from an imbalance between LV closing forces and mitral valve tethering forces, and resultant deformation of mitral valve geometry ...

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Low-dose dobutamine test associated with interventricular dyssynchrony: A useful tool to identify cardiac resynchronization therapy responders

Cited by 24 publications

References 39 publications

Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease

Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease

Acute contractile recovery extent during biventricular pacing is not associated with follow-up in patients undergoing resynchronization

Predictors of functional mitral regurgitation improvement during a short-term follow-up after cardiac resynchronisation therapy

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