Document Detail


The additive prognostic value of restrictive pattern and dipyridamole-induced contractile reserve in idiopathic dilated cardiomyopathy.
MedLine Citation:
PMID:  16087138     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Diastolic dysfunction and lack of contractile reserve are unfavorable prognostic predictors in patients with dilated cardiomyopathy (DCM).
AIMS: This study aims to assess whether diastolic dysfunction and lack of dipyridamole-induced contractile reserve were additive predictors of poor outcome in patients with DCM.
METHODS: A total of 116 patients with DCM and ejection fraction (EF<35%) were studied by dipyridamole echo (0.84 mg/kg over 10 min). At rest, a restrictive filling pattern was defined as: E/A ratio >2 and an E-wave deceleration time of <140 ms on transmitral flow velocity profile.
RESULTS: Rest wall motion score index (WMSI) was 2.2+/-0.3 and decreased to 1.9+/-0.41 after dipyridamole (p<0.001). During follow-up (median 26.5 months), 22 cardiac deaths occurred. At multivariate analysis, dipyridamole-induced contractile reserve yielded significant incremental prognostic value (RR=0.275, p<0.006) over NYHA class (RR=1.971, p<0.03), angiotensin-converting enzyme inhibitor therapy (RR=0.173, p<0.001), and left ventricular end-diastolic diameter (RR=1.131, p<0.001). The worst prognostic combination was the presence of restrictive pattern at rest and the absence of contractile reserve (deltaWMSI<0.15).
CONCLUSION: In patients with DCM, the ominous combination of restrictive transmitral flow pattern and lack of contractile reserve during dipyridamole stress predicts an unfavourable outcome.
Authors:
Lorenza Pratali; Petar Otasevic; Fausto Rigo; Sonia Gherardi; Aleksandar Neskovic; Eugenio Picano
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  European journal of heart failure     Volume:  7     ISSN:  1388-9842     ISO Abbreviation:  Eur. J. Heart Fail.     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-08-09     Completed Date:  2005-12-13     Revised Date:  2011-06-08    
Medline Journal Info:
Nlm Unique ID:  100887595     Medline TA:  Eur J Heart Fail     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  844-51     Citation Subset:  IM    
Affiliation:
Institute of Clinical Physiology, CNR, Via G. Moruzzi no. 1, Pisa 56124, Italy. lorenza@ifc.cnr.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiomyopathy, Dilated / mortality*,  physiopathology*
Dipyridamole / diagnostic use
Echocardiography, Stress
Female
Humans
Male
Middle Aged
Myocardial Contraction
Prognosis
Proportional Hazards Models
Prospective Studies
Survival Analysis
Vasodilator Agents / diagnostic use
Chemical
Reg. No./Substance:
0/Vasodilator Agents; 58-32-2/Dipyridamole

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


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