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Clinical Investigations: CARDIOLOGY |

Prognostic Value of Low-Dose Dobutamine Echocardiography in Patients With Idiopathic Dilated Cardiomyopathy*

Jaroslaw Drożdż, MD; Maria Krzemińska-Pakula, MD, PhD; Michal Plewka, MD; Michal Ciesielczyk, MD; Jaroslaw D. Kasprzak, MD, PhD
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*From the Department of Cardiology, Medical University of Lódź, Lódź, Poland.

Correspondence to: Jaroslaw Drożdż, MD, Department of Cardiology, Medical University of Lódź, Kniaziewicza 1/5, 91 347 Lódź, Poland; e-mail: drozdz@ptkardio.pl



Chest. 2002;121(4):1216-1222. doi:10.1378/chest.121.4.1216
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Study objectives: Dobutamine echocardiography is widely used for the evaluation of myocardial contractile reserve. The purpose of the study was to determine the prognostic value of low-dose dobutamine echocardiography in patients with idiopathic dilated cardiomyopathy (IDCM).

Patients: The study group consisted of 77 consecutive patients with recently diagnosed IDCM (mean [± SD] age, 49 ± 9 years; men, 82%) and left ventricular (LV) ejection fractions of < 40%.

Interventions: Two-dimensional and Doppler echocardiographic variables were measured before and after the infusion of dobutamine at the rate of 10 μg/kg/min for 5 min.

Measurements and results: During a mean follow-up period of 63 ± 7 months (range, 49 to 75 months) 30 patients (39%) died and five patients (6%) underwent successful heart transplantations. Using multivariate regression analysis, the only significant factors related to fatal outcome or the need for cardiac transplantation were the following: (1) LV end-systolic volume of > 150 mL after low-dose dobutamine infusion (odds ratio [OR], 2.2; confidence interval [CI], 1.2 to 4.1; p = 0.011); (2) no decrease of LV end-diastolic volume after dobutamine infusion (OR, 1.9; CI, 1.1 to 3.4; p = 0.031); (3) atrial fibrillation (OR, 2.7; CI, 1.4 to 5.3; p = 0.003); and (4) male gender (OR, 2.6; CI, 1.2 to 5.5; p = 0.017). A scoring system was proposed with one point assigned for each of the above-mentioned factors. The mortality rates for total scores of 0, 1, 2, 3, and 4 were 0%, 19%, 48%, 83%, and 100%, respectively.

Conclusion: The response of the LV to low-dose dobutamine infusion adds clinically valuable prognostic information to the evaluation of the patient with IDCM.

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