The Independent Prognostic Value of Contractile and Coronary Flow Reserve Determined by Dipyridamole Stress Echocardiography in Patients With Idiopathic Dilated Cardiomyopathy
The aim of this study was to evaluate the prognostic value of Doppler echocardiographically derived coronary flow reserve (CFR) in assessing inotropic response in patients with idiopathic dilated cardiomyopathy (IDC). One hundred thirty-two patients with IDC (90 men; mean age 62 ± 11 years) were eva...
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| Veröffentlicht in: | The American journal of cardiology 2007-04, Vol.99 (8), p.1154-1158 |
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| creator | Rigo, Fausto, MD Gherardi, Sonia, MD Galderisi, Maurizio, MD Sicari, Rosa, MD Picano, Eugenio, MD, PhD |
| description | The aim of this study was to evaluate the prognostic value of Doppler echocardiographically derived coronary flow reserve (CFR) in assessing inotropic response in patients with idiopathic dilated cardiomyopathy (IDC). One hundred thirty-two patients with IDC (90 men; mean age 62 ± 11 years) were evaluated by transthoracic dipyridamole (0.84 mg/kg in 10 minutes) stress echocardiography. All patients had ejection fractions 0.25. All patients were followed for a median of 24 months. Mean CFR was 2.0 ± 0.5. On individual patient analysis, 48 patients had normal CFR (>2), and 84 had abnormal CFR. The mean wall motion score index at rest was 2.0 ± 0.33 and decreased to 1.8 ± 0.4 at peak dipyridamole dose (p |
| doi_str_mv | 10.1016/j.amjcard.2006.11.049 |
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One hundred thirty-two patients with IDC (90 men; mean age 62 ± 11 years) were evaluated by transthoracic dipyridamole (0.84 mg/kg in 10 minutes) stress echocardiography. All patients had ejection fractions <40% (mean 33 ± 7%) and angiographically normal coronary arteries, with New York Heart Association class ≤III. CFR was assessed in the left anterior descending coronary artery by pulsed Doppler as the ratio of maximal peak vasodilation (dipyridamole) to rest diastolic flow velocity. Inotropic reserve was identified as rest-stress variation in wall motion score index >0.25. All patients were followed for a median of 24 months. Mean CFR was 2.0 ± 0.5. On individual patient analysis, 48 patients had normal CFR (>2), and 84 had abnormal CFR. The mean wall motion score index at rest was 2.0 ± 0.33 and decreased to 1.8 ± 0.4 at peak dipyridamole dose (p <0.000). Forty-two patients (32%) had inotropic reserve. During follow-up, 19 patients died, and 34 showed worsening of New York Heart Association class. The worst outcomes were observed in those patients with abnormal CFR and no inotropic reserve with high-dose dipyridamole. In a Cox model, mitral insufficiency (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.1 to 2.8), New York Heart Association class (HR 2.0, 95% CI 1.1 to 3.7), abnormal CFR (HR 2.8, 95% CI 1.0 to 8.5), wall motion score index at rest (HR 3.5, 95% CI 1.3 to 9.8), and the absence of inotropic reserve with high-dose dipyridamole (HR 2.3, 95% CI 1.06 to 5.1) were independent predictors of survival. In conclusion, in patients with IDC, CFR is often impaired. Reduced CFR and the absence of an inotropic response during vasodilator stress are additive in predicting a worse prognosis.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2006.11.049</identifier><identifier>PMID: 17437747</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Blood Flow Velocity - drug effects ; Blood Flow Velocity - physiology ; Bundle-Branch Block - physiopathology ; Cardiac Output, Low - physiopathology ; Cardiology ; Cardiomyopathy, Dilated - diagnostic imaging ; Cardiomyopathy, Dilated - physiopathology ; Cardiovascular ; Cardiovascular disease ; Clinical outcomes ; Coronary Angiography ; Coronary Circulation - drug effects ; Coronary Circulation - physiology ; Coronary vessels ; Dipyridamole ; Echocardiography, Doppler, Pulsed ; Echocardiography, Stress ; Female ; Follow-Up Studies ; Humans ; Male ; Medical imaging ; Medical prognosis ; Middle Aged ; Mitral Valve Insufficiency - physiopathology ; Myocardial Contraction - drug effects ; Myocardial Contraction - physiology ; Prognosis ; Prospective Studies ; Stroke Volume - drug effects ; Stroke Volume - physiology ; Survival Rate ; Ultrasonic imaging ; Vasodilator Agents ; Ventricular Function - drug effects ; Ventricular Function - physiology</subject><ispartof>The American journal of cardiology, 2007-04, Vol.99 (8), p.1154-1158</ispartof><rights>Elsevier Inc.</rights><rights>2007 Elsevier Inc.</rights><rights>Copyright Elsevier Sequoia S.A. Apr 15, 2007</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c445t-7f0d5dae708ec3075135686c95b3aa4611f1ebd7157e0b18aff487411ff0648a3</citedby><cites>FETCH-LOGICAL-c445t-7f0d5dae708ec3075135686c95b3aa4611f1ebd7157e0b18aff487411ff0648a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0002914907000562$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17437747$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rigo, Fausto, MD</creatorcontrib><creatorcontrib>Gherardi, Sonia, MD</creatorcontrib><creatorcontrib>Galderisi, Maurizio, MD</creatorcontrib><creatorcontrib>Sicari, Rosa, MD</creatorcontrib><creatorcontrib>Picano, Eugenio, MD, PhD</creatorcontrib><title>The Independent Prognostic Value of Contractile and Coronary Flow Reserve Determined by Dipyridamole Stress Echocardiography in Patients With Idiopathic Dilated Cardiomyopathy</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>The aim of this study was to evaluate the prognostic value of Doppler echocardiographically derived coronary flow reserve (CFR) in assessing inotropic response in patients with idiopathic dilated cardiomyopathy (IDC). One hundred thirty-two patients with IDC (90 men; mean age 62 ± 11 years) were evaluated by transthoracic dipyridamole (0.84 mg/kg in 10 minutes) stress echocardiography. All patients had ejection fractions <40% (mean 33 ± 7%) and angiographically normal coronary arteries, with New York Heart Association class ≤III. CFR was assessed in the left anterior descending coronary artery by pulsed Doppler as the ratio of maximal peak vasodilation (dipyridamole) to rest diastolic flow velocity. Inotropic reserve was identified as rest-stress variation in wall motion score index >0.25. All patients were followed for a median of 24 months. Mean CFR was 2.0 ± 0.5. On individual patient analysis, 48 patients had normal CFR (>2), and 84 had abnormal CFR. The mean wall motion score index at rest was 2.0 ± 0.33 and decreased to 1.8 ± 0.4 at peak dipyridamole dose (p <0.000). Forty-two patients (32%) had inotropic reserve. During follow-up, 19 patients died, and 34 showed worsening of New York Heart Association class. The worst outcomes were observed in those patients with abnormal CFR and no inotropic reserve with high-dose dipyridamole. In a Cox model, mitral insufficiency (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.1 to 2.8), New York Heart Association class (HR 2.0, 95% CI 1.1 to 3.7), abnormal CFR (HR 2.8, 95% CI 1.0 to 8.5), wall motion score index at rest (HR 3.5, 95% CI 1.3 to 9.8), and the absence of inotropic reserve with high-dose dipyridamole (HR 2.3, 95% CI 1.06 to 5.1) were independent predictors of survival. In conclusion, in patients with IDC, CFR is often impaired. Reduced CFR and the absence of an inotropic response during vasodilator stress are additive in predicting a worse prognosis.</description><subject>Blood Flow Velocity - drug effects</subject><subject>Blood Flow Velocity - physiology</subject><subject>Bundle-Branch Block - physiopathology</subject><subject>Cardiac Output, Low - physiopathology</subject><subject>Cardiology</subject><subject>Cardiomyopathy, Dilated - diagnostic imaging</subject><subject>Cardiomyopathy, Dilated - physiopathology</subject><subject>Cardiovascular</subject><subject>Cardiovascular disease</subject><subject>Clinical outcomes</subject><subject>Coronary Angiography</subject><subject>Coronary Circulation - drug effects</subject><subject>Coronary Circulation - physiology</subject><subject>Coronary vessels</subject><subject>Dipyridamole</subject><subject>Echocardiography, Doppler, Pulsed</subject><subject>Echocardiography, Stress</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Medical prognosis</subject><subject>Middle Aged</subject><subject>Mitral Valve Insufficiency - physiopathology</subject><subject>Myocardial Contraction - drug effects</subject><subject>Myocardial Contraction - physiology</subject><subject>Prognosis</subject><subject>Prospective Studies</subject><subject>Stroke Volume - drug effects</subject><subject>Stroke Volume - physiology</subject><subject>Survival Rate</subject><subject>Ultrasonic imaging</subject><subject>Vasodilator Agents</subject><subject>Ventricular Function - drug effects</subject><subject>Ventricular Function - physiology</subject><issn>0002-9149</issn><issn>1879-1913</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFUsFu1DAQjRCILoVPAFkcuG3wxEmcXEBoty0rVaKiBY6W1550vSR2sL1F-Sp-sd7uCqReuNie8XtvxvOcZa-B5kChfr_N5bBV0uu8oLTOAXJatk-yGTS8nUML7Gk2o5QW8xbK9iR7EcI2hQBV_Tw7AV4yzks-y_7cbJCsrMYR02IjufLu1roQjSLfZb9D4jqycDZ6qaLpkUirU-ydlX4i5737Tb5iQH-HZIkR_WAsarKeyNKMkzdaDi6RrqPHEMiZ2rh9y8bdejluJmIsuZLRpLqB_DBxQ1bpbpRxk6ovTS9j0lo8EIbpIT-9zJ51sg_46rifZt_Oz24Wn-eXXy5Wi0-Xc1WWVZzzjupKS-S0QcUor4BVdVOrtlozKcsaoANcaw4VR7qGRnZd2fAypTtal41kp9m7g-7o3a8dhigGExT2vbTodkFwypoiqSbg20fArdt5m3oTBaNpyoxBAlUHkPIuBI-dGL0Z0gQFULG3U2zF0U6xt1MAiGRn4r05iu_WA-p_rKN_CfDxAMA0izuDXgSVxqlQG48qCu3Mf0t8eKSgemONkv1PnDD8fQyIUAgqrvd_av-lKE-nqi7YPVR0y4k</recordid><startdate>20070415</startdate><enddate>20070415</enddate><creator>Rigo, Fausto, MD</creator><creator>Gherardi, Sonia, MD</creator><creator>Galderisi, Maurizio, MD</creator><creator>Sicari, Rosa, MD</creator><creator>Picano, Eugenio, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20070415</creationdate><title>The Independent Prognostic Value of Contractile and Coronary Flow Reserve Determined by Dipyridamole Stress Echocardiography in Patients With Idiopathic Dilated Cardiomyopathy</title><author>Rigo, Fausto, MD ; Gherardi, Sonia, MD ; Galderisi, Maurizio, MD ; Sicari, Rosa, MD ; Picano, Eugenio, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c445t-7f0d5dae708ec3075135686c95b3aa4611f1ebd7157e0b18aff487411ff0648a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Blood Flow Velocity - drug effects</topic><topic>Blood Flow Velocity - physiology</topic><topic>Bundle-Branch Block - physiopathology</topic><topic>Cardiac Output, Low - physiopathology</topic><topic>Cardiology</topic><topic>Cardiomyopathy, Dilated - diagnostic imaging</topic><topic>Cardiomyopathy, Dilated - physiopathology</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Clinical outcomes</topic><topic>Coronary Angiography</topic><topic>Coronary Circulation - drug effects</topic><topic>Coronary Circulation - physiology</topic><topic>Coronary vessels</topic><topic>Dipyridamole</topic><topic>Echocardiography, Doppler, Pulsed</topic><topic>Echocardiography, Stress</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical prognosis</topic><topic>Middle Aged</topic><topic>Mitral Valve Insufficiency - physiopathology</topic><topic>Myocardial Contraction - drug effects</topic><topic>Myocardial Contraction - physiology</topic><topic>Prognosis</topic><topic>Prospective Studies</topic><topic>Stroke Volume - drug effects</topic><topic>Stroke Volume - physiology</topic><topic>Survival Rate</topic><topic>Ultrasonic imaging</topic><topic>Vasodilator Agents</topic><topic>Ventricular Function - drug effects</topic><topic>Ventricular Function - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rigo, Fausto, MD</creatorcontrib><creatorcontrib>Gherardi, Sonia, MD</creatorcontrib><creatorcontrib>Galderisi, Maurizio, MD</creatorcontrib><creatorcontrib>Sicari, Rosa, MD</creatorcontrib><creatorcontrib>Picano, Eugenio, MD, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rigo, Fausto, MD</au><au>Gherardi, Sonia, MD</au><au>Galderisi, Maurizio, MD</au><au>Sicari, Rosa, MD</au><au>Picano, Eugenio, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Independent Prognostic Value of Contractile and Coronary Flow Reserve Determined by Dipyridamole Stress Echocardiography in Patients With Idiopathic Dilated Cardiomyopathy</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2007-04-15</date><risdate>2007</risdate><volume>99</volume><issue>8</issue><spage>1154</spage><epage>1158</epage><pages>1154-1158</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>The aim of this study was to evaluate the prognostic value of Doppler echocardiographically derived coronary flow reserve (CFR) in assessing inotropic response in patients with idiopathic dilated cardiomyopathy (IDC). One hundred thirty-two patients with IDC (90 men; mean age 62 ± 11 years) were evaluated by transthoracic dipyridamole (0.84 mg/kg in 10 minutes) stress echocardiography. All patients had ejection fractions <40% (mean 33 ± 7%) and angiographically normal coronary arteries, with New York Heart Association class ≤III. CFR was assessed in the left anterior descending coronary artery by pulsed Doppler as the ratio of maximal peak vasodilation (dipyridamole) to rest diastolic flow velocity. Inotropic reserve was identified as rest-stress variation in wall motion score index >0.25. All patients were followed for a median of 24 months. Mean CFR was 2.0 ± 0.5. On individual patient analysis, 48 patients had normal CFR (>2), and 84 had abnormal CFR. The mean wall motion score index at rest was 2.0 ± 0.33 and decreased to 1.8 ± 0.4 at peak dipyridamole dose (p <0.000). Forty-two patients (32%) had inotropic reserve. During follow-up, 19 patients died, and 34 showed worsening of New York Heart Association class. The worst outcomes were observed in those patients with abnormal CFR and no inotropic reserve with high-dose dipyridamole. In a Cox model, mitral insufficiency (hazard ratio [HR] 1.7, 95% confidence interval [CI] 1.1 to 2.8), New York Heart Association class (HR 2.0, 95% CI 1.1 to 3.7), abnormal CFR (HR 2.8, 95% CI 1.0 to 8.5), wall motion score index at rest (HR 3.5, 95% CI 1.3 to 9.8), and the absence of inotropic reserve with high-dose dipyridamole (HR 2.3, 95% CI 1.06 to 5.1) were independent predictors of survival. In conclusion, in patients with IDC, CFR is often impaired. Reduced CFR and the absence of an inotropic response during vasodilator stress are additive in predicting a worse prognosis.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>17437747</pmid><doi>10.1016/j.amjcard.2006.11.049</doi><tpages>5</tpages></addata></record> |
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| subjects | Blood Flow Velocity - drug effects Blood Flow Velocity - physiology Bundle-Branch Block - physiopathology Cardiac Output, Low - physiopathology Cardiology Cardiomyopathy, Dilated - diagnostic imaging Cardiomyopathy, Dilated - physiopathology Cardiovascular Cardiovascular disease Clinical outcomes Coronary Angiography Coronary Circulation - drug effects Coronary Circulation - physiology Coronary vessels Dipyridamole Echocardiography, Doppler, Pulsed Echocardiography, Stress Female Follow-Up Studies Humans Male Medical imaging Medical prognosis Middle Aged Mitral Valve Insufficiency - physiopathology Myocardial Contraction - drug effects Myocardial Contraction - physiology Prognosis Prospective Studies Stroke Volume - drug effects Stroke Volume - physiology Survival Rate Ultrasonic imaging Vasodilator Agents Ventricular Function - drug effects Ventricular Function - physiology |
| title | The Independent Prognostic Value of Contractile and Coronary Flow Reserve Determined by Dipyridamole Stress Echocardiography in Patients With Idiopathic Dilated Cardiomyopathy |
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