Document Detail


Dobutamine stress echocardiography predicts myocardial improvement in patients supported by left ventricular assist devices (LVADs): hemodynamic and histologic evidence of improvement before LVAD explantation.
MedLine Citation:
PMID:  12581761     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Cardiac function may improve in patients with end-stage heart failure who receive long-term support (>30 days) with left ventricular assist devices (LVADs). Dobutamine stress echocardiography (DSE) has been used to quantitate myocardial recovery in patients with heart failure supported with LVADs. By recording the hemodynamic response with the use of DSE, we evaluated and applied the resulting data to patients receiving LVAD support. METHODS AND RESULTS: The study population included 16 patients who underwent LVAD implantation, regained functional capacity on full LVAD support, and tolerated decreased mechanical support with no worsening of dyspnea or fatigue. All 16 patients underwent dobutamine stress with increasing doses of dobutamine (from 5 to 40 mcg/kg/min). Hemodynamics and 2-dimensional (2-D) echocardiography was performed at each dose level. In addition, paired myocardial samples were obtained and analyzed histologically to determine myocyte size and collagen content. Dobutamine stress separated the study population into 2 groups: those who had favorable responses to dobutamine (9/16) and those who had unfavorable responses (i.e., experienced hemodynamic deterioration; 7/16). Favorable dobutamine responses were characterized by improved cardiac index, improved force-frequency relationship in the left ventricle (dP/dt), improved left ventricular ejection fraction, and decreased left ventricular end-diastolic dimension. All 9 favorable responders underwent LVAD explantation, and 6 survived for more than 12 months. In all patients studied, LVAD support resulted in decreased myocyte size (n = 14, 33.9 +/- 0.9 microm before vs 16.6 +/- 0.8 microm after support, p = 0.0001; normal, 5-15 microm) but resulted in no consistent changes in collagen content. CONCLUSIONS: Dobutamine stress echocardiography with hemodynamic assessment may be a useful tool in assessing physiologic improvement in myocardial function of patients with end-stage heart failure who receive LVAD support. It may help predict which patients can tolerate LVAD removal. Prospective analysis of cardiac function is now warranted to better define myocardial recovery in patients supported with LVADs.
Authors:
Tehreen Khan; Reynolds M Delgado; Brano Radovancevic; Guillermo Torre-Amione; Jackie Abrams; Kathy Miller; Timothy Myers; Kristen Okerberg; Sonny J Stetson; Igor Gregoric; Antonita Hernandez; O H Frazier
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation     Volume:  22     ISSN:  1053-2498     ISO Abbreviation:  J. Heart Lung Transplant.     Publication Date:  2003 Feb 
Date Detail:
Created Date:  2003-02-12     Completed Date:  2003-08-29     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9102703     Medline TA:  J Heart Lung Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  137-46     Citation Subset:  IM    
Affiliation:
Department of Cardiopulmonary Transplantation at the Texas Heart Institute at St Luke's Episcopal Hospital, Houston, Texas 77225-0345, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Cardiomyopathy, Dilated / physiopathology,  therapy*,  ultrasonography
Case-Control Studies
Device Removal
Echocardiography, Stress*
Female
Heart-Assist Devices*
Hemodynamics*
Humans
Male
Myocardial Contraction
Myocardial Ischemia / physiopathology,  therapy*,  ultrasonography
Myocardium / pathology
Myocytes, Cardiac / pathology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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