| Myocardial contractile reserve by dobutamine stress echocardiography predicts improvement in ejection fraction with beta-blockade in patients with heart failure: the Beta-Blocker Evaluation of Survival Trial (BEST). | |
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MedLine Citation:
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PMID: 14597587 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: beta-Blockers improve survival and reduce hospitalization in chronic heart failure (CHF) by biologically improving left ventricular ejection fraction (LVEF). However, a good predictor of improvement with this therapy has not been identified. This substudy of BEST examined whether myocardial contractile reserve, as determined by dobutamine stress echocardiography, predicts improvement in LVEF. METHODS AND RESULTS: Seventy-nine patients with class III/IV CHF underwent dobutamine stress echocardiography before treatment with bucindolol (n=41) or placebo (n=38). Regional wall motion score index (WMSI) was calculated as the sum of the scores in each segment divided by the total number of segments visualized. WMSI was compared with change in LVEF after 3 months of therapy as determined by gated radionuclide scan. Change in WMSI correlated inversely with change in LVEF after 3 months of bucindolol (r=-0.72, P<0.0001) and was the most significant multivariate predictor of change in LVEF (P=0.0002). Patients with contractile reserve had demographics similar to those of patients without contractile reserve, including RVEF, LVEF, systolic blood pressure, and CHF duration. However, patients without contractile reserve had higher baseline plasma norepinephrine levels (687+/-333 versus 420+/-246 pg/mL, P<0.05) and greater decrease in plasma norepinephrine in response to bucindolol (-249+/-171 versus -35+/-277 pg/mL, P<0.05). CONCLUSIONS: This study suggests a direct relationship between contractile reserve and improvement in LVEF with beta-blocker therapy in patients with advanced CHF. Patients without contractile reserve have higher resting adrenergic drive, as reflected by plasma norepinephrine, and may experience greater sympatholytic effects from bucindolol. |
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Authors:
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Eric J Eichhorn; Paul A Grayburn; Susan A Mayer; Martin St John Sutton; Christopher Appleton; Jonathan Plehn; Jae Oh; Barry Greenberg; Anthony DeMaria; Robert Frantz; Heidi Krause-Steinrauf |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.; Research Support, U.S. Gov't, P.H.S. Date: 2003-11-03 |
Journal Detail:
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Title: Circulation Volume: 108 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2003 Nov |
Date Detail:
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Created Date: 2003-11-11 Completed Date: 2003-12-08 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2336-41 Citation Subset: AIM; IM |
Affiliation:
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Department of Internal Medicine, Cardiology Division, the University of Texas Southwestern and Dallas VA Medical Centers, Dallas, USA. eeichhorn@csant.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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pharmacology,
therapeutic use* Adult Aged Aged, 80 and over Dobutamine / administration & dosage, adverse effects, diagnostic use* Echocardiography, Stress* Female Follow-Up Studies Heart Failure / blood, drug therapy, physiopathology*, radionuclide imaging Humans Male Middle Aged Myocardial Contraction / drug effects, physiology* Norepinephrine / blood Propanolamines / pharmacology, therapeutic use* Prospective Studies Stroke Volume / drug effects Ventricular Function, Left / drug effects |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Propanolamines; 34368-04-2/Dobutamine; 51-41-2/Norepinephrine; 70369-47-0/bucindolol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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