Abstract
Objective: Levosimendan improves symptoms and the hemodynamic profile in patients with acutely decompensated chronic heart failure (ADCHF). We aimed to investigate: the association of low dose dobutamine (DSE)-induced changes of two-dimensional strain parameters with the corresponding changes of left ventricular ejection fraction (LVEF) and left ventricular outflow tract velocity time integral (LVOT VTI) in patients with ADCHF, and whether left ventricular contractile reserve assessed by both conventional and speckle tracking echocardiography is associated with clinical and neurohumoral improvement after levosimendan treatment. Methods: Thirty one consecutive patients with ADCHF (mean age 65 ± 10 years, NYHA class 3.6 ± 0.3, LVEF 22 ± 6%) were studied by DSE (peak dose 20 μg/kg/min) prior to 24-hour infusion of levosimendan (0.01 μg/kg/min, without bolus). The LVEF, LVOT VTI, mean longitudinal, circumferential and radial strain and strain rate using speckle tracking imaging were measured. Results: Twenty-three patients (74%) had evidence of contractile reserve (increase of LVEF > 10% and LVOT VTI > 20% after peak dobutamine dose, CR+), and 8 (26%) showed no reserve (CR−). CR+ versus CR- patients demonstrated greater improvement of NYHA class (mean NYHA change: −1.0±0.5 vs −0.5±0.3 NYHA class, p=0.01), and reduction of b-type natriuretic peptide levels (− 34±30 vs + 4±31%, p <0.01) 48 hours after completion of treatment. By multivariate analysis, mean longitudinal systolic strain rate reserve (resting - peak longitudinal strain rate ΔLSR (%)) was the best predictor of improvement of NYHA class (p= 0.039) and BNP (p= 0.042) after levosimendan administration among the reserve of: LV FS, EF, LVOT VTI, longitudinal strain, circumferential and radial strain and strain rate. Conclusion: Dobutamine-induced reserve of 2-dimentional speckle tracking longitudinal systolic strain rate is associated with clinical and neurohumoral improvement after treatment with levosimendan in patients with ADCHF.
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