Global myocardial contractile reserve assessed by high-dose dobutamine stress echocardiography predicts response to the cardiac resynchronization therapy

Echocardiography. 2015 Mar;32(3):490-5. doi: 10.1111/echo.12694. Epub 2014 Jul 24.

Abstract

Background: Myocardial contractile reserve (CR) is a strong prognostic factor in patients with heart failure. The presence of significant myocardial fibrosis can lead to a reduced response to cardiac resynchronization therapy (CRT). We assumed that myocardial CR assessed by high-dose dobutamine stress echocardiography (DSE) would predict response to CRT.

Methods: Fifty-two consecutive symptomatic patients with heart failure (New York Heart Association [NYHA] class III), with depressed ejection fraction (EF) of the left ventricle (26.3 ± 6.9%) and dyssynchronous contractions (QRS duration 149.8 ± 23.8 msec) underwent DSE before CRT implantation. The difference in EF at rest and at peak (40 μg/kg per minute) DSE indicated global CR. Responders to CRT were defined by a decrease in left ventricular end-systolic volume of ≥15% and/or an increase in EF of ≥5% after 6 months of CRT.

Results: During high-dose dobutamine infusion, responders (28 patients, 54%) showed a greater increase in EF compared with nonresponders (Δ 11 ± 7% vs. Δ 2 ± 9%, P = 0.007). CR correlated moderately with an improvement in EF after 6 months of CRT (r = 0.50, P = 0.0009). Furthermore, responders showed significant improvement in clinical status, evaluated by a reduction in NYHA functional class (-0.8 ± 0.6 vs. 0.1 ± 0.4, P = 0.02), compared with nonresponders. A 7% exercise-induced increase in EF yielded sensitivity of 79% and specificity of 87% in predicting the response to CRT after 6 months.

Conclusions: Myocardial CR assessed by high-dose DSE can play a potentially important role in identifying responders to CRT.

Keywords: cardiac resynchronization therapy; myocardial viability; stress echocardiography.

Publication types

  • Clinical Trial

MeSH terms

  • Cardiac Resynchronization Therapy*
  • Dobutamine / administration & dosage*
  • Echocardiography, Stress / methods*
  • Exercise Test / methods
  • Female
  • Fractional Flow Reserve, Myocardial
  • Heart Failure / complications
  • Heart Failure / diagnostic imaging*
  • Heart Failure / therapy*
  • Humans
  • Male
  • Middle Aged
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Treatment Outcome
  • Vasodilator Agents / administration & dosage
  • Ventricular Dysfunction, Left / diagnostic imaging*
  • Ventricular Dysfunction, Left / etiology
  • Ventricular Dysfunction, Left / prevention & control

Substances

  • Vasodilator Agents
  • Dobutamine