Copyright © 2000 by the European Society of Cardiology.
Low-dose dobutamine responsiveness in idiopathic dilated cardiomyopathy: relation to exercise capacity and clinical outcome
a Division of Cardiology, "Salvatore Maugeri" Foundation, IRCCS, Rehabilitation Institute of Cassano Murge, Bari, Italy
b Institute of Cardiology, University of Bari, Bari, Italy
revised September 2, 1999; accepted September 8, 1999
Abstract
Aims To evaluate myocardial contractile reserve using low-dose dobutamine echocardiography in patients with chronic heart failure secondary to idiopathic dilated cardiomyopathy stratified by peak exercise oxygen consumption (VO2).
Methods and Results Sixty clinically stable patients (56±11 years; 45 males) with idiopathic cardiomyopathy and NYHA class I to III symptoms of heart failure were studied and followed-up for 13±3 months. All patients underwent cardiopulmonary exercise testing and low-dose dobutamine. The dobutamine infusion protocol consisted of an initial dose of 2·5µ.kg–1per 3min, increasing by 2·5µ.kg–1per min every 3min; the maximal dose was 10µ.kg–1per min. The end-systolic volume index, left ventricular ejection fraction and cardiac output were measured at baseline and peak dobutamine dose and their change calculated as ((peak dose value-baseline value)/baseline value]x100. Ten normal subjects with normal left ventricular function and no coronary artery lesions served as a control group to compare low-dose dobutamine results. All analysed echocardiographic variables either at baseline or following dobutamine infusion were significantly lower in patients with chronic heart failure as a whole compared to the control group. When the patients were grouped according to Weber's classification, a statistically significant decrease in percentange changes in end-systolic volume index (
=–0·77;P<0·0001), left ventricular ejection fraction (=–0·72;P<0·0001) and cardiac output (=–0·82;P<0·0001) from class A to class C was observed. The mean percentage decrease in end-systolic volume index following the dobutamine infusion was 28·7±9% in class A (peak VO2>20ml.kg–1.min–1), 18·6±8% in class B (peak VO2between 16 and 20ml.kg.min–1), and only 6·4±6% in class C (peak VO2between 10 and 16ml.kg–1.min–1) patient groups. At multivariate analysis, only the percentage change in end-systolic volume index was significantly associated with a peak VO2<15ml.kg–1.min–1(P=0·006). During the follow-up, 17 patients had events (15 readmissions for worsening heart failure and two deaths). At multivariate analysis, only the percentage change in end-systolic volume index was significantly associated with the occurrence of events (P=0·003). The area under the receiver operating characteristic curve for percentage change in end-systolic volume index was not significantly different from that for peak VO2(0·86±0·04 vs 0·80±0·06;P:ns).
Conclusion This study indicates that in patients with chronic heart failure secondary to idiopathic cardiomyopathy, the cardiac response to low-dose dobutamine, as assessed by echocardiography, is correlated with peak VO2, an objective and accurate measure of the severity of the disease and clinical outcome.
Key Words: Low-dose dobutamine • idiopathic dilated cardiomyopathy • peak VO2
f1 Correspondence: Dr Domenico Scrutinio, Fondazione "S. Maugeri", IRCCS, Centro Medico di Riabilitazione, Via per Mercadante, Km 2, 70024 Cassano Murge (Bari). Italy.
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