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Clinical Investigations: CARDIOLOGY |

Dobutamine Gated Blood Pool Scintigraphy Predicts the Improvement of Cardiac Sympathetic Nerve Activity, Cardiac Function, and Symptoms After Treatment in Patients With Dilated Cardiomyopathy*

Shu Kasama, MD; Takuji Toyama, MD; Hiroshi Hoshizaki, MD; Shigeru Oshima, MD; Koichi Taniguchi, MD; Tadashi Suzuki, MD; Masahiko Kurabayashi, MD
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*From The Second Department of Internal Medicine (Drs. Kasama, Toyama, Suzuki, and Kurabayashi), Gunma University School of Medicine, Maebashi; and Gunma Prefectural Cardiovascular Center (Drs. Hoshizaki, Oshima, and Taniguchi), Maebashi, Japan.

Correspondence to: Shu Kasama, MD, The Second Department of Internal Medicine, Gunma University School of Medicine, 3-39-15, Shouwa-machi, Maebashi, Gunma 371-0034, Japan; e-mail: s-kasama@bay.wind.ne.jp



Chest. 2002;122(2):542-548. doi:10.1378/chest.122.2.542
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Background: We evaluated whether dobutamine gated blood pool scintigraphy (DOB-GBP) can predict improvement in cardiac sympathetic nerve activity and cardiac function after β-blocker therapy in patients with dilated cardiomyopathy (DCM).

Methods and results: Twenty-two patients with DCM underwent DOB-GBP to measure left ventricular ejection fraction (LVEF) at rest, and during 5, 10, and 15 μg/kg/min of dobutamine infusion before therapy. Examinations were performed before and after 1 year of therapy. The heart/mediastinum count (H/M) ratio and total defect score (TDS) were determined for 123I-meta-iodobenzylguanidine images from anterior planar image and single-photon emission CT images. LVEF and left ventricular end-diastolic dimension (LVDd) were determined by echocardiography. After 1 year of treatment, the echocardiographic LVEF improved > 5% in 11 patients (group A), but did not improve in the remaining 11 patients (group B). Before treatment, TDS, H/M, LVEF, and LVDd were similar in both groups. However, there was a greater increase in the LVEF during dobutamine infusion in group A than in group B (21 ± 8% vs 9 ± 3%, p < 0.001). If a critical value of 15% for the ΔLVEF was used to predict the improvement in LVEF after treatment, the sensitivity was 91% and specificity was 82%. The TDS, H/M ratio, LVDd, and New York Heart Association functional class improved in group A to a greater extent than in group B.

Conclusions: DOB-GBP can be used to predict improved cardiac sympathetic nerve activity, cardiac function, and symptoms after treatment in patients with DCM.

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