Dobutamine-induced changes of left atrial two-dimensional deformation predict clinical and neurohumoral improvement after levosimendan treatment in patients with acutely decompensated chronic heart failure

Abstract

Background: We investigated whether dobutamine-induced changes of the left atrial (LA) two-dimensional speckle tracking parameters are related to clinical and neurohumoral improvement after levosimendan treatment in patients with acutely decompensate chronic heart failure (ADCHF).

Methods: Forty-six patients with ADCHF and LV ejection fraction <35%, were studied using dobutamine stress echocardiography before a 24-hour infusion of levosimendan. In a multivariable model, we included: dobutamine-induced LV contractile reserve, change (%) of LA volume, LV longitudinal strain rate and LA speckle tracking parameters to assess the improvement of NYHA class, 6-min walk distance and brain natriuretic peptide (BNP).

Results: The change (%) of LA-contractile strain and LV longitudinal stain rate were independent determinants of improvement of NYHA class, and BNP and increase in the 6-min walk test distance (b=-0.59, b=-0.65, b=0.41, and b=-0.44, b=-0.40, b=0.60, respectively, p<0.05). The addition of LA-contractile strain change in the multivariable analysis including LV longitudinal stain rate change increased the value of the model from r(2)=0.46 to 0.58 for NYHA improvement and from r(2)=0.44 to 0.70, for the BNP reduction and from r(2)=0.49 to 0.60, for increase in the 6-min walk test distance (p<0.05). The change (%) of LA-reservoir strain was univariate determinant for increase in the 6-min walk test distance (b=-0.37, p=0.02) and increased the value of the multivariate model from r(2)=0.46 to 0.58, p=0.02.

Conclusion: In patients with ADCHF, left atrial two-dimensional speckle tracking parameters in addition to LV longitudinal strain rate may detect those patients who are prone to improve after levosimendan treatment.