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Adv Med Sci. 2015 Sep;60(2):294-9. doi: 10.1016/j.advms.2015.04.004. Epub 2015 May 5.

Low-dose dobutamine stress echo for reverse remodeling prediction after cardiac resynchronization.

Author information

1
1st Department of Cardiology, Medical University of Silesia, Katowice, Poland.
2
Department of Cardiology, Pomeranian Medical University, Szczecin, Poland.
3
1st Department of Cardiology, Medical University of Silesia, Katowice, Poland. Electronic address: wowr@wp.pl.
4
Department of Coronary Disease, Institute of Cardiology, Jagiellonian University, Cracow, Poland.
5
2nd Department of Cardiology, Medical University of Silesia, Katowice, Poland.
6
Department of Cardiology, Medical University of Łódź, Łódź, Poland.
7
1st Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland.
8
2nd Department of Cardiology, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland.
9
2nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland.

Abstract

PURPOSE:

Cardiac resynchronization therapy (CRT) is a valuable option for patients with heart failure and wide QRS to reduce electromechanical dyssynchrony (DYS). High non-responders rate (30%) urges the need to improve selection of candidates for CRT. We hypothesized that low-dose dobutamine stress echocardiography (DSE) can help unmask dyssynchronous motion. The aim of this study is comparison between dyssynchrony index at rest and during low-dose dobutamine stress to predict left ventricular reverse remodeling after CRT.

PATIENTS AND METHODS:

Prospectively, 57 consecutive patients (37 male) aged 61.8±9 who qualified for CRT according to current guidelines were enrolled. Two dimensional echocardiography and tissue Doppler imaging (TDI) were performed before and 6 month after CRT to assess reverse remodeling (rLV). Additionally DSE was performed before CRT. DYS was assessed at rest (DYSr) and peak DSE (DYSd) separately, as a difference between time to peak systolic velocity (Ts) of septum and lateral wall. Ts was corrected for heart rate.

RESULTS:

rLV defined as decrease ≥15% of LVESV at follow-up was found in 38 (67%) patients. DYSr and DYSd were independent predictors of rLV (OR=1.04, Cl ±1.02-1.06, p<0.02 and OR=1.05, Cl±1.03-1.08, p<0.0002 respectively). ROC analysis found that DYSr>42ms and DYSd>59ms had sensitivity of 70% and 87%, specificity of 61% and 78%, and accuracy of 70% and 84% respectively for prediction of reverse remodeling LV. Area under Receiver Operating Characteristic Curve for DYSd was higher than for DYSr (0.89 vs 0.71, p<0.007).

CONCLUSION:

Exercise intraventricular dyssynchrony assessed by dobutamine stress echo is a strong independent predictor of cardiac resynchronization therapy response.

KEYWORDS:

Dobutamine stress echocardiography; Responders for CRT; Resynchronization

PMID:
26117588
DOI:
10.1016/j.advms.2015.04.004
[Indexed for MEDLINE]

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