Using isoproterenol stress echocardiography to predict the response to carvedilol in patients with dilated cardiomyopathy

Trials have demonstrated that carvedilol can produce hemodynamic, symptomat ic, and prognostic improvements in dilated cardiomyopathy (DCM), but some D CM patients have deteriorated after carvedilol, developing congestive heart failure. The present study investigated the use of isoproterenol (ISP) str ess echocardiography to select those patients with DCM who would respond to carvedilol. ISP was infused intravenously in 22 patients with DCM and they were classified into 2 groups based on the left ventricular systolic respo nse: good response to TSP [change in fractional shortening (FS) with ISP >0 .05, n = 13] and poor response to ISP (change less than or equal to0.05, n = 9). In the good response group, FS significantly increased from 0.12 +/- 0.04 to 0.17 +/- 0.08 (mean +/- SD, p < 0.05) with carvedilol, and ? patien ts improved symptomatically (New York Heart Association class). However, in the poor response group, no significant difference was observed between FS at baseline and that at the end of follow-up. Moreover, only I patient in the poor response group improved symptomatically. ISP stress echocardiograp hy can assist in selecting patients with DCM who will respond positively to carvedilol.