Low dose dobutamine stress echocardiography predicts the improvement of left ventricular systolic function in dilated cardiomyopathy

Objective-To determine whether dobutamine stress echocardiography can predi ct the improvement of left ventricular systolic function in patients with d ilated cardiomyopathy (DCM). Methods-Myocardial contractile reserve, as assessed by dobutamine stress ec hocardiography, was determined in 18 patients with DCM (mean (SD) age 53 (1 3) years, left ventricular ejection fraction (LVEF) 28 (10)%) and compared with changes in LVEF during a follow up period of 15 (8) months. The LVEF a nd regional left ventricular wall motion score (0, normal to 4, dyskinesis) of 12 segments in short axis and four chamber views were analysed before a nd after dobutamine infusion (5-20 mu g/kg/min ). Results-During a follow up period of 15 (8) months, a significant improveme nt in LVEF (> 20%) was found in seven patients but not in the remaining 11. Baseline haemodynamic findings were similar in both groups. Patients with an improvement in follow up LVEF showed a greater change in wall motion sco re from baseline during dobutamine infusion than patients with no improveme nt (at rest, 1.7 (0.4) v 1.9 (0.2), NS; dobutamine 10 mu g/kg/min, 0.6 (0.4 ) v 1.2 (0.4), p < 0.05). The percentage change in LVEF during dobutamine i nfusion was also significantly greater in patients who showed improvement t han in those who did not. The change in LVEF during the follow up period (f ollow up LVEF/baseline LVEF) correlated well with the change in LVEF during dobutamine stress (LVEF at rest/ LVEF at dobutamine 10 mu g/kg/min; r = 0. 74, p < 0.001). Conclusions-Changes in left ventricular systolic performance during low dos e dobutamine stress echocardiography are a useful marker to predict the out come of left ventricular systolic function in patients with DCM.