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European Heart Journal 2001 22(10):849-856; doi:10.1053/euhj.2001.2654
Copyright © 2001 by the European Society of Cardiology.
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Dobutamine-induced augmentation of left ventricular ejection fraction predicts survival of heart failure patients with severe non-ischaemic cardiomyopathy

T.M Ramahia,f1, M.D Longob, A.R Cadariua, K Rohlfsa, M Sladea, S Carolana, E Vallejoa and F.J.Th Wackersa

a Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT, U.S.A.
b Division of Cardiology, University of Turin, Molinette Hospital, Turin, Italy

Received November 26, 2000; accepted February 15, 2001

Abstract

Aims The prognosis of patients with severe non-ischaemic dilated cardiomyopathy is variable. The predictive value of currently utilized tests is suboptimal. The purpose of this study was to determine the prognostic value of dobutamineinduced augmentation of left ventricular ejection fraction in patients with non-ischaemic dilated cardiomyopathy.

Methods and Results Sixty-two patients with left ventricular ejection fraction ≤0·30 underwent exercise testing with gas exchange analysis and assessment of left ventricular ejection fraction at rest and after a 10-min intravenous infusion of dobutamine at 10µg.kg–1min–1, using equilibrium radionuclide ventriculography. Age was 48±11 years, 32% females, functional class 2·6±0·6, resting left ventricular ejection fraction 0·20±0·06, and peak exercise oxygen consumption (mVO2) 19±6ml.kg–1min–1. Mean dobutamine-induced augmentation of left ventricular ejection fraction ({Delta}LVEF) was 0·09±0·06 (median 0·08, range –0·03 to 0·26). Follow-up was 25±15 months during which there were 12 deaths and five transplantations. Patients were divided into two groups based on median {Delta}LVEF. The transplant-free survival was better in the group with higher {Delta}LVEF (94% vs 64%, P<0·008). In multivariate analysis incorporating age, gender, duration of chronic heart failure, functional class, right and left ventricular ejection fraction, {Delta}LVEF, left ventricular end-diastolic volume index, and mVO2, only {Delta}LVEF was predictive of 1-year, 3-year, and overall transplant-free survival (RR0·09, 0·03, and 0·13;P 0·03, 0·09, and 0·08 respectively). The linear correlation between {Delta}LVEF and mVO2(r=0·3) and between {Delta}LVEF and left ventricular ejection fraction (r=0·5) was weak.

Conclusion Dobutamine-induced augmentation of left ventricular ejection fraction is a strong prognostic variable, independent of exercise capacity and resting ventriculographic variables, in severe non-ischaemic systolic dysfunctional heart failure.

Key Words: Heart failure, cardiomyopathy, inotropic reserve, prognosis

f1 Correspondence Tarik M. Ramahi, MD, 135 College Street, Suite 301, New Haven, CT 06510-2483, U.S.A.


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