Dobutamine Stress Testing as a Diagnostic Tool for Evaluation of Myocardial Contractile Reserve in Asymptomatic or Mildly Symptomatic Patients With Dilated Cardiomyopathy
Dobutamine Stress Testing as a Diagnostic Tool for Evaluation of Myocardial Contractile Reserve in Asymptomatic or Mildly Symptomatic Patients With Dilated Cardiomyopathy
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DOI：
10.1016/j.jcmg.2008.04.012
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发表时间：
2008-11-01
影响因子：
14
通讯作者：
Yokota, Mitsuhiro
中科院分区：
文献类型：
--
作者：
Kobayashi, Masakazu;Izawa, Hideo;Yokota, Mitsuhiro
我们进行了多巴酚丁胺负荷试验来评估无症状或轻度症状的扩张型心肌病（DCM）患者的心肌收缩储备。背景由于β-肾上腺素能受体信号通路的心肌异常，心力衰竭患者对儿茶酚胺的敏感性降低。然而，很少有人知道肾上腺素能心肌收缩储备在无症状或轻度症状的患者与DCM.METHODS左心室压力（LV dP/dt（最大））的最大一阶导数多巴酚丁胺（10 μ g kg（-1）分（-1））在46无症状或轻度症状（纽约心脏协会功能I级或II级）DCM患者的输液过程中测定。通过逆转录和实时聚合酶链反应分析，定量分析肌内膜活检标本中收缩调节蛋白的信使核糖核酸（mRNA）表达。结果根据多巴酚丁胺引起的左室dP/dt（max）增加百分比，将患者分为3组，分别为123碘苄胍（MIBG）组、123碘苄胍组和123碘苄胍组（Δ LV dP/dt（max））和LV射血分数（LVEF）：组I（n = 18）：Δ LV dP/dt（max）> 100%和LVEF > 25%;组IIa（n = 17）：Delta LV dP/dt（最大值）25%; IIb组（n = 11）：Delta LV dP/dt（最大值）
OBJECTIVES We performed dobutamine stress testing for evaluation of myocardial contractile reserve in asymptomatic or mildly symptomatic patients with dilated cardiomyopathy (DCM).BACKGROUND Catecholamine sensitivity is reduced in failing hearts as a result of myocardial abnormalities in the beta-adrenergic receptor signaling pathway. However, little is known about adrenergic myocardial contractile reserve in asymptomatic or mildly symptomatic patients with DCM.METHODS The maximal first derivative of left ventricular pressure (LV dP/dt(max)) was determined during infusion of dobutamine (10 mu g kg(-1) min(-1)) in 46 asymptomatic or mildly symptomatic (New York Heart Association functional class I or II) patients with DCM. The expression of messenger ribonucleic acid (mRNA) for contractile regulatory proteins in endomyocardial biopsy specimens was quantified by reverse transcription and real-time polymerase chain reaction analysis. Plasma norepinephrine levels were measured in all patients and [I-123]metaiodobenzylguanidine (MIBG) scintigraphy performed.RESULTS Patients were classified into 3 groups based on the percentage increase in LV dP/dt(max) induced by dobutamine (Delta LV dP/dt(max)) and on LV ejection fraction (LVEF) at baseline: group I (n = 18): Delta LV dP/dt(max) > 100% and LVEF > 25%; group IIa (n = 17): Delta LV dP/dt(max) 25%; and group IIb (n = 11): Delta LV dP/dt(max)