Abstract
A number of studies have suggested that stress-echocardiography may be used for prognostic stratification in patients with idiopathic dilated cardiomyopathy. There is no consensus on which protocol or which measurements of left ventricular contractile reserve to use. The most frequently used protocol is low-dose dobutamine stress-echocardiography, and most commonly used measures of left ventricular systolic performance are ejection fraction, wall motion score index and cardiac power output.Stress-echocardiography has been shown to predict improvement in cardiac function in patients with recently diagnosed dilated cardiomyopathy, as well as to predict which patients will benefit from the treatment with beta-blockers. Most importantly, stress-echocardiography can identify patients with worse prognosis in terms of cardiac death and need for transplantation. Additionally, contractile reserve is closely correlated with maximal oxygen consumption and can even be used for further stratification in patients with maximal oxygen consumption between 10 and 14 ml/kg/min.Future studies are needed for head-to-head comparison of various protocols in an attempt to make standardization in the assessment of patients with dilated cardiomyopathy.
Highlights
Epidemiologic data from United States indicate that idiopathic dilated cardiomyopathy (DCM) is diagnosed in approximately 36/100.000 persons each year, and that it is responsible for more than 10.000 deaths per year [1]
Faced with the fact that the number of patients with DCM is constantly increasing [2], accurate assessment of patient's current status and prognosis is of the utmost importance for the implementation of optimal therapeutic algorithm as well as for the optimal utilization of resources
There is a widespread belief that maximal oxygen consumption, assessed by cardiopulmonary testing, is one of most, if not the most important prognostic variables in DCM patients [3]
Summary
Shattuck lecture – Cardiovascular medicine at the turn of the millennium: triumphs, concerns, and opportunities. 4. Mancini D, Eisen H, Kussmaul W: Value of peak oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Mannor A, Shneeweiss A: Prognostic value of noninvasively obtained left ventricular contractile reserve in patients with severe heart failure. Nagaoka H, Isobe N, Kubota S, Iizuka , Imai S, Suzuki T, Nagai R: Myocardial contractile reserve as prognostic determinant in patients with idiopathic dilated cardiomyopathy without overt heart failure.
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