Morimoto Ryota, Okumura Takahiro, Hirashiki Akihiro, Ishii Hideki, Ichii Takeo, Aoki Soichiro, Furusawa Kenji, Hiraiwa Hiroaki, Kondo Toru, Watanabe Naoki, Kano Naoaki, Fukaya Kenji, Sawamura Akinori, Takeshita Kyosuke, Bando Yasuko K, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
J Cardiol. 2017 Oct;70(4):303-309. doi: 10.1016/j.jjcc.2017.02.005. Epub 2017 Mar 18.
Catecholamine sensitivity estimated using a dobutamine stress test (DST) is recognized as a measure of the beta-adrenergic myocardial contractile reserve, which is involved with left ventricular reverse remodeling (LV-RR). We investigated whether the prognostic ability of the DST for LV-RR could predict cardiac events.
There was a total of 192 enrolled patients with dilated cardiomyopathy (DCM). DCM was defined as a LV ejection fraction (LV-EF) ≤45% and LV end-diastolic dimension (LVDd) ≥55mm. One hundred patients were subjected to micromanometer-based measurement of the maximal first derivative of LV pressure (LVdP/dt), an index of LV contractility, at baseline and following the infusion of dobutamine (10μg/kg/min) via a pigtail catheter. Percentage changes in LVdP/dt from the baseline to peak values under dobutamine stress (ΔLVdP/dt) were also calculated. After excluding 17 patients who received cardiac resynchronization therapy within 3 months of undergoing DST (n=15) and who did not receive follow-up echocardiography (n=2), 83 patients were enrolled (52.5±12.3 years).
During the follow-up period (4.7±2.6 years), LV-RR was recognized in 49 of 83 patients (59.0%). A multivariate logistic regression analysis revealed that ΔLVdP/dt (hazard ratio: 1.024, p=0.007) and the symptom duration (hazard ratio: 0.977, p=0.003) were independent predictors of LV-RR. A receiver operating characteristic curve analysis revealed a ΔLVdP/dt cut-off value of 75.1% for LV-RR and a significantly lower cardiac event rate in the ΔLVdP/dt≥75.1% group (p=0.045).
ΔLVdP/dt estimated using DST was a useful predictor of LV-RR and cardiac events in patients with DCM.
使用多巴酚丁胺负荷试验（DST）评估的儿茶酚胺敏感性被认为是β-肾上腺素能心肌收缩储备的一种测量方法，其与左心室逆向重构（LV-RR）有关。我们研究了DST对LV-RR的预后评估能力是否能够预测心脏事件。
共有192例扩张型心肌病（DCM）患者入组。DCM定义为左心室射血分数（LV-EF）≤45%且左心室舒张末期内径（LVDd）≥55mm。100例患者在基线时以及通过猪尾导管输注多巴酚丁胺（10μg/kg/min）后，接受基于微测压计的左心室压力最大一阶导数（LVdP/dt）测量，LVdP/dt是左心室收缩性的一个指标。还计算了多巴酚丁胺负荷下LVdP/dt从基线到峰值的百分比变化（ΔLVdP/dt）。在排除17例在接受DST后3个月内接受心脏再同步治疗的患者（n = 15）以及未接受随访超声心动图检查的患者（n = 2）后，83例患者入组（年龄52.5±12.3岁）。
在随访期间（4.7±2.6年），83例患者中有49例（59.0%）出现LV-RR。多因素逻辑回归分析显示，ΔLVdP/dt（风险比：1.024，p = 0.007）和症状持续时间（风险比：0.977，p = 0.003）是LV-RR的独立预测因素。受试者工作特征曲线分析显示，LV-RR的ΔLVdP/dt临界值为75.1%，且在ΔLVdP/dt≥75.1%组中心脏事件发生率显著更低（p = 0.045）。
使用DST评估的ΔLVdP/dt是DCM患者LV-RR和心脏事件的有用预测指标。
