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document
Prognostic significance of the dobutamine echocardiography test in idiopathic dilated cardiomyopathy . Dobutamine stress echo provides potentially useful information on idiopathic dilated cardiomyopathy ( IDC ) . From February 1 , 1997 , to October 1 , 1999 , 186 patients ( 131 men and 55 women , mean age 56 +/- 12 years ) with IDC , ejection fraction < 35 % , and angiographically normal coronary arteries were studied by high-dose ( up to 40 micro/kg/min ) dobutamine echo in 6 centers , all quality controlled for stress echo reading . In all patients , wall motion score index ( WMSI ) ( from 1 = normal to 4 = dyskinetic in a 16- segment model of the left ventricle ) was evaluated by echo at baseline and peak dobutamine . One hundred eighty-four patients were followed up ( mean 15 +/- 13 months ) and only cardiac death was considered as an end point . There were 29 cardiac deaths . Significant parameters for survival prediction at univariate analysis are : DeltaWMSI ( chi-square 20.1 ; p < 0.0000 ) , New York Heart Association ( NYHA ) class ( chi-square 17.57 ; p < 0.0000 ) , rest ejection fraction ( chi-square 10.41 ; p = 0.0013 ) , angiotensin-converting enzyme inhibitors ( chi-square 8.23 ; p = 0.0041 ) , and hypertension ( chi-square 8.08 , p = 0.0045 ) . In the multivariate stepwise analysis only DeltaWMSI and NYHA were independent predictors of outcome ( DeltaWMSI = hazard ratio 0.02 , p < 0.0000 ; NYHA class = hazard ratio 3.83 , p < 0.0000 ) . Kaplan-Meier survival estimates showed a better outcome for patients with a large inotropic response ( DeltaWMSI > or =0.44 , a cutoff identified by receiver-operating characteristic curves analysis ) than for those with a small or no myocardial inotropic response to dobutamine ( 93.6 % vs 69.4 % , p = 0.00033 ) . Thus , in patients with IDC , an extensive contractile reserve identified by high-dose dobutamine stress echocardiography is associated with a better survival .
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Intervention_Physical
Dobutamine stress echo
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Intervention_Surgical
idiopathic dilated cardiomyopathy
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Intervention_Physical
dobutamine echo
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Outcome_Physical
idiopathic dilated cardiomyopathy .
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Outcome_Physical
cardiac death
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Outcome_Other
better outcome
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Outcome_Physical
large inotropic response
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Outcome_Mortality
better survival .