Myocardial contractile reserve predicts left ventricular reverse remodeling and cardiac events in dilated cardiomyopathy
Myocardial contractile reserve predicts left ventricular reverse remodeling and cardiac events in dilated cardiomyopathy
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DOI：
10.1016/j.jjcc.2017.02.005
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发表时间：
2017-09-01
影响因子：
2.5
通讯作者：
Murohara, Toyoaki
中科院分区：
文献类型：
--
作者：
Morimoto, Ryota;Okumura, Takahiro;Murohara, Toyoaki
背景：使用多巴酚丁胺负荷试验（DST）估计的儿茶酚胺敏感性被认为是β-肾上腺素能心肌收缩储备的衡量标准，这与左心室逆重构（LV-RR）有关。我们研究了 LV-RR 的 DST 的预后能力是否可以预测心脏事件。方法：共有 192 名扩张型心肌病 (DCM) 患者入组。 DCM 定义为 LV 射血分数 (LV-EF) = 55 mm。一百名患者在基线时和通过猪尾导管输注多巴酚丁胺（10μg/kg/min）后，接受了基于微压计的左室压力最大一阶导数（LVdP/dt(max)）（左室收缩指数）的测量。还计算了多巴酚丁胺应激下 LVdP/dt(max) 从基线到峰值的百分比变化 (Delta LVdP/dt(max))。排除 17 名接受 DST 后 3 个月内接受心脏再同步治疗的患者 (n = 15) 以及未接受随访超声心动图检查 (n = 2) 的患者后，纳入 83 名患者（52.5 +/- 12.3 年）。 结果：在随访期间（4.7 +/- 2.6 年），83 名患者中有 49 名 (59.0%) 被识别为 LV-RR。多变量逻辑回归分析显示，Delta LVdP/dt(max)（风险比：1.024，p = 0.007）和症状持续时间（风险比：0.977，p = 0.003）是 LV-RR 的独立预测因子。受试者工作特征曲线分析显示，LV-RR 的 Delta LVdP/dt(max) 截止值为 75.1%，Delta LVdP/dt(max) >= 75.1% 组的心脏事件发生率显着降低 (p = 0.045)。结论：使用 DST 估计的 Delta LVdP/dt(max) 是 DCM 患者 LV-RR 和心脏事件的有用预测因子。 (C) 2017 年日本心脏病学院。由爱思唯尔有限公司出版。保留所有权利。
Background: Catecholamine sensitivity estimated using a dobutamine stress test (DST) is recognized as a measure of the beta-adrenergic myocardial contractile reserve, which is involved with left ventricular reverse remodeling (LV-RR). We investigated whether the prognostic ability of the DST for LV-RR could predict cardiac events.Methods: There was a total of 192 enrolled patients with dilated cardiomyopathy (DCM). DCM was defined as a LV ejection fraction (LV-EF) = 55 mm. One hundred patients were subjected to micromanometer-based measurement of the maximal first derivative of LV pressure (LVdP/dt(max)), an index of LV contractility, at baseline and following the infusion of dobutamine (10 mu g/kg/min) via a pigtail catheter. Percentage changes in LVdP/dt(max) from the baseline to peak values under dobutamine stress (Delta LVdP/dt(max)) were also calculated. After excluding 17 patients who received cardiac resynchronization therapy within 3 months of undergoing DST (n = 15) and who did not receive follow-up echocardiography (n = 2), 83 patients were enrolled (52.5 +/- 12.3 years).Results: During the follow-up period (4.7 +/- 2.6 years), LV-RR was recognized in 49 of 83 patients (59.0%). A multivariate logistic regression analysis revealed that Delta LVdP/dt(max) (hazard ratio: 1.024, p = 0.007) and the symptom duration (hazard ratio: 0.977, p = 0.003) were independent predictors of LV-RR. A receiver operating characteristic curve analysis revealed a Delta LVdP/dt(max) cut-off value of 75.1% for LV-RR and a significantly lower cardiac event rate in the Delta LVdP/dt(max) >= 75.1% group (p = 0.045).Conclusions: Delta LVdP/dt(max) estimated using DST was a useful predictor of LV-RR and cardiac events in patients with DCM. (C) 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.