Abstract 17398: Prediction of Improvement in Cardiac Function by Dobutamine Echocardiography in Patients with Recent Onset Dilated Cardiomyopathy

Abstract

Background: Clinical and echocardiographic variables have been used to predict prognosis in patients with DCM. The aim of this study was to investigate whether the contractile reserve on dobutamine stress echocardiography (DSE) could predict the myocardial contractile reversibility or prognosis in patients with recent-onset DCM. Method: High-dose DSE was performed in 22 patients with recently diagnosed DCM in incremental stages lasting 5 min each. Left ventricular (LV) volume and ejection fraction (EF) was measured by Simpson's biplane method. LV end-systolic elastance (Ees), effective arterial elastance (Ea) and ventriculo-vascular coupling index (VVID) were also calculated. A follow-up echocardiography was done at 9±6 months. Results: Fourteen patients were men and age was 46±16 years. Resting LVEF, LV end-diastolic volume and LV end-systolic volume was 24±6%, 174±53 mL and 133±44 mL. LVEF were increased to 31±9% at low dose dobutamine and to 36±9% at peak dose dobutamine stimulation. Follow-up LVEF was 39±15% after 9±6 months . Resting LVEF, LV volume, stroke volume, E/E', Ees, Ea and VVID could not predict follow-up LVEF. However, LVEF, LV volumes, Ees and VVID at peak dose on high-dose DSE, not at low dose, was well correlated with follow-up LVEF, especially peak LVEF was most strongly correlated (Fig 1). During follow-up period, 3 died of cardiac causes and 5 readmitted for aggravation of heart failure. In patients with cardiac events, LVEF was lower, LV volumes were higher and changes of LVEF from resting to peak dobutamine were lower. The addition of high-dose DSE resulted in significant incremental improvement in the predictive value of the other parameters (Fig 2). Conclusion: High-dose DSE could predict late spontaneous improvement in cardiac function in patients with recent-onset DCM and had prognostic values for future cardiac events.