CardiomyopathyThe Independent Prognostic Value of Contractile and Coronary Flow Reserve Determined by Dipyridamole Stress Echocardiography in Patients With Idiopathic Dilated Cardiomyopathy
Section snippets
Methods
From May 1, 1997, to December 31, 2005, 142 patients were prospectively enrolled from the cardiology divisions at Umberto Hospital, Mestre (n = 53) and Italy Cesena Hospital (n = 48); the Institute of Clinical Physiology, Pisa, National Council of Research (n = 28); and Italy Department of Medicine, Federico II University, Naples (n = 13). The study population consisted of patients with IDC presenting with (1) global severe LV dysfunction (ejection fraction <40% by the biplane area-length
Results
The main clinical and echocardiographic data are listed in Table 1. The time from symptom onset to stress testing was 48 ± 53 months. WMSI at rest was 2.0 ± 0.33 and decreased to 1.8 ± 0.4 at peak dipyridamole dose (p <0.000). Forty-two (32%) patients were considered responders (ΔWMSI ≥0.25), and the remaining 90 (68%) had ΔWMSI values <0.25. The mean CFR value was 2.0 ± 0.5. On individual patient analysis, 48 patients had normal CFR (>2), and 84 had abnormal CFR. There was no correlation
Discussion
In patients with IDC, abnormal CFR detectable by Doppler echocardiography identifies a subset of patients at higher risk for spontaneous events (death and worsening of clinical status). This information is additive to that provided by the echocardiographic assessment of LV contractile reserve: when the 2 parameters are analyzed, the stratification ability improves, because those patients with no inotropic reserve and reduced CFR <2 have the worst outcomes.
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