Otasevic Petar, Tasic Nebojsa, Vidakovic Radoslav, Boskovic Srdjan, Radak Djordje, Djukanovic Bosko, Angelkov Lazar, Kostic Nada, Caparevic Zorica, Vasiljevic-Pokrajcic Zorana
Dr Aleksandar D. Popovic Cardiovascular Research Center, Dedinje Cardiovascular Institute and Belgrade University Medical School, Belgrade, Serbia.
J Clin Ultrasound. 2012 Sep;40(7):405-9. doi: 10.1002/jcu.21903. Epub 2012 Mar 10.
We and others have shown previously that left ventricular (LV) contractile reserve assessed quantitatively by high-dose dobutamine stress-echocardiography (DSE) has prognostic implications in patients with dilated cardiomyopathy.
To assess the feasibility of semi-quantitative assessment of LV contractile reserve by differently skilled operators in patients with dilated cardiomyopathy.
High-dose DSE was performed in 63 consecutive patients, mean age 50 ± 10 years and ejection fraction (EF) 19 ± 8%. LVEF was calculated 1) using Simpson's biplane formula, and 2) semi-quantitatively (5% increments) by novice and experienced echocardiographers, and by a DSE expert. Patients were considered to have preserved LV contractile reserve if LVEF dobutamine-induced change was ≥5%.
Twenty-seven (45.8%) patients died during the 5-year follow-up. The feasibility of the assessment was 89%, 94%, and 98% for novice and experienced readers and DSE expert, respectively. Kaplan-Meier analysis showed that LV contractile reserve assessed semi-quantitatively by DSE expert and experienced reader achieved the best prognostic separation (log rank 19.63 and 18.99, respectively, p < 0.001 for both), followed by quantitative assessment (log rank 9.76, p = 0.0018) and assessment by novice reader (log rank 8.76, p = 0.012). Areas under the curves were similar for quantitative and semi-quantitative assessment of LV contractile reserve.
Our data indicate that semi-quantitative assessment of LV contractile reserve is feasible by differently skilled operators.
我们和其他研究团队之前已经表明，通过高剂量多巴酚丁胺负荷超声心动图（DSE）定量评估的左心室（LV）收缩储备对扩张型心肌病患者具有预后意义。
评估不同技术水平的操作者对扩张型心肌病患者进行左心室收缩储备半定量评估的可行性。
对63例连续患者进行高剂量DSE检查，平均年龄50±10岁，射血分数（EF）为19±8%。左心室射血分数（LVEF）的计算方法有两种：1）使用双平面Simpson公式；2）由新手和经验丰富的超声心动图医生以及DSE专家进行半定量评估（以5%的增量）。如果多巴酚丁胺诱导的LVEF变化≥5%，则认为患者左心室收缩储备保留。
在5年随访期间，27例（45.8%）患者死亡。新手、经验丰富的阅片者和DSE专家评估的可行性分别为89%、94%和98%。Kaplan-Meier分析表明，DSE专家和经验丰富的阅片者进行的半定量评估左心室收缩储备实现了最佳的预后区分（对数秩分别为19.63和18.99，两者p均<0.001），其次是定量评估（对数秩9.76，p = 0.0018）和新手阅片者的评估（对数秩8.76，p = 0.012）。左心室收缩储备的定量和半定量评估的曲线下面积相似。
我们的数据表明，不同技术水平的操作者对半定量评估左心室收缩储备是可行的。
