Inotropic contractile reserve and response to cardiac resynchronization therapy in patients with markedly remodeled left ventricle

Farooq A. Chaudhry, Ajay Shah, Sripal Bangalore, Joseph DeRose, Jonathan S. Steinberg

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Recently concluded multicenter studies have shown that none of an array of echocardiographic indicators of ventricular dyssynchrony have enough sensitivity and specificity for predicting response to cardiac resynchronization therapy (CRT). Inotropic contractile reserve (ICR) on dobutamine stress echocardiography can differentiate viable myocardium from scar and is a predictor of improvement in regional and global left ventricular function in patients with cardiomyopathy. Its role in patients undergoing CRT is unknown. The aim of this study was to evaluate the role of ICR in predicting response to CRT in patients with markedly remodeled left ventricles. Methods: Fifty-four patients (mean age, 69 ± 11 years; 63% men) referred for clinically indicated CRT were evaluated. All patients underwent low-dose dobutamine stress echocardiography to assess for ICR, defined as an improvement in contractility in more than five of 16 left ventricular segments. Results: During a mean follow-up period of 206 ± 167 days, 31 patients (57%) were responders, as defined by a 5-point increase in ejection fraction after CRT. The presence of ICR was a stronger predictor of response to CRT (area under the curve, 0.94; χ2 = 39.0; P < .0001) compared with dyssynchrony (area under the curve, 0.74; χ2 = 10.07; P = .002). It was a significant predictor of response (odds ratio, 2.84; 95% confidence interval, 1.59 to 5.09; P < .0001), even after controlling for the other predictors, and provided incremental prognostic value beyond that provided by QRS duration and dyssynchrony (increase in area under the curve from 0.47 to 0.75 to 0.93; P = .030 and P = .008). Conclusions: In patients referred for CRT, ICR was a stronger predictor of response and provided incremental value beyond that of current known predictors of response to CRT (dyssynchrony and QRS duration). Dobutamine stress echocardiography may have an important role in identifying CRT responders, and further multicenter studies are needed to confirm this.

Original languageEnglish (US)
Pages (from-to)91-97
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume24
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Fingerprint

Cardiac Resynchronization Therapy
Heart Ventricles
Stress Echocardiography
Area Under Curve
Multicenter Studies
Cardiomyopathies
Left Ventricular Function
Cicatrix
Myocardium
Odds Ratio
Confidence Intervals
Sensitivity and Specificity

Keywords

  • Cardiac resynchronization therapy
  • Dobutamine
  • Dyssynchrony
  • Echocardiography
  • Inotropic contractile reserve
  • Stress

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Inotropic contractile reserve and response to cardiac resynchronization therapy in patients with markedly remodeled left ventricle. / Chaudhry, Farooq A.; Shah, Ajay; Bangalore, Sripal; DeRose, Joseph; Steinberg, Jonathan S.

In: Journal of the American Society of Echocardiography, Vol. 24, No. 1, 01.2011, p. 91-97.

Research output: Contribution to journalArticle

@article{f975e6c2f3064eccbfae72c7f82cd7e6,
title = "Inotropic contractile reserve and response to cardiac resynchronization therapy in patients with markedly remodeled left ventricle",
abstract = "Background: Recently concluded multicenter studies have shown that none of an array of echocardiographic indicators of ventricular dyssynchrony have enough sensitivity and specificity for predicting response to cardiac resynchronization therapy (CRT). Inotropic contractile reserve (ICR) on dobutamine stress echocardiography can differentiate viable myocardium from scar and is a predictor of improvement in regional and global left ventricular function in patients with cardiomyopathy. Its role in patients undergoing CRT is unknown. The aim of this study was to evaluate the role of ICR in predicting response to CRT in patients with markedly remodeled left ventricles. Methods: Fifty-four patients (mean age, 69 ± 11 years; 63{\%} men) referred for clinically indicated CRT were evaluated. All patients underwent low-dose dobutamine stress echocardiography to assess for ICR, defined as an improvement in contractility in more than five of 16 left ventricular segments. Results: During a mean follow-up period of 206 ± 167 days, 31 patients (57{\%}) were responders, as defined by a 5-point increase in ejection fraction after CRT. The presence of ICR was a stronger predictor of response to CRT (area under the curve, 0.94; χ2 = 39.0; P < .0001) compared with dyssynchrony (area under the curve, 0.74; χ2 = 10.07; P = .002). It was a significant predictor of response (odds ratio, 2.84; 95{\%} confidence interval, 1.59 to 5.09; P < .0001), even after controlling for the other predictors, and provided incremental prognostic value beyond that provided by QRS duration and dyssynchrony (increase in area under the curve from 0.47 to 0.75 to 0.93; P = .030 and P = .008). Conclusions: In patients referred for CRT, ICR was a stronger predictor of response and provided incremental value beyond that of current known predictors of response to CRT (dyssynchrony and QRS duration). Dobutamine stress echocardiography may have an important role in identifying CRT responders, and further multicenter studies are needed to confirm this.",
keywords = "Cardiac resynchronization therapy, Dobutamine, Dyssynchrony, Echocardiography, Inotropic contractile reserve, Stress",
author = "Chaudhry, {Farooq A.} and Ajay Shah and Sripal Bangalore and Joseph DeRose and Steinberg, {Jonathan S.}",
year = "2011",
month = "1",
doi = "10.1016/j.echo.2010.10.007",
language = "English (US)",
volume = "24",
pages = "91--97",
journal = "Journal of the American Society of Echocardiography",
issn = "0894-7317",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Inotropic contractile reserve and response to cardiac resynchronization therapy in patients with markedly remodeled left ventricle

AU - Chaudhry, Farooq A.

AU - Shah, Ajay

AU - Bangalore, Sripal

AU - DeRose, Joseph

AU - Steinberg, Jonathan S.

PY - 2011/1

Y1 - 2011/1

N2 - Background: Recently concluded multicenter studies have shown that none of an array of echocardiographic indicators of ventricular dyssynchrony have enough sensitivity and specificity for predicting response to cardiac resynchronization therapy (CRT). Inotropic contractile reserve (ICR) on dobutamine stress echocardiography can differentiate viable myocardium from scar and is a predictor of improvement in regional and global left ventricular function in patients with cardiomyopathy. Its role in patients undergoing CRT is unknown. The aim of this study was to evaluate the role of ICR in predicting response to CRT in patients with markedly remodeled left ventricles. Methods: Fifty-four patients (mean age, 69 ± 11 years; 63% men) referred for clinically indicated CRT were evaluated. All patients underwent low-dose dobutamine stress echocardiography to assess for ICR, defined as an improvement in contractility in more than five of 16 left ventricular segments. Results: During a mean follow-up period of 206 ± 167 days, 31 patients (57%) were responders, as defined by a 5-point increase in ejection fraction after CRT. The presence of ICR was a stronger predictor of response to CRT (area under the curve, 0.94; χ2 = 39.0; P < .0001) compared with dyssynchrony (area under the curve, 0.74; χ2 = 10.07; P = .002). It was a significant predictor of response (odds ratio, 2.84; 95% confidence interval, 1.59 to 5.09; P < .0001), even after controlling for the other predictors, and provided incremental prognostic value beyond that provided by QRS duration and dyssynchrony (increase in area under the curve from 0.47 to 0.75 to 0.93; P = .030 and P = .008). Conclusions: In patients referred for CRT, ICR was a stronger predictor of response and provided incremental value beyond that of current known predictors of response to CRT (dyssynchrony and QRS duration). Dobutamine stress echocardiography may have an important role in identifying CRT responders, and further multicenter studies are needed to confirm this.

AB - Background: Recently concluded multicenter studies have shown that none of an array of echocardiographic indicators of ventricular dyssynchrony have enough sensitivity and specificity for predicting response to cardiac resynchronization therapy (CRT). Inotropic contractile reserve (ICR) on dobutamine stress echocardiography can differentiate viable myocardium from scar and is a predictor of improvement in regional and global left ventricular function in patients with cardiomyopathy. Its role in patients undergoing CRT is unknown. The aim of this study was to evaluate the role of ICR in predicting response to CRT in patients with markedly remodeled left ventricles. Methods: Fifty-four patients (mean age, 69 ± 11 years; 63% men) referred for clinically indicated CRT were evaluated. All patients underwent low-dose dobutamine stress echocardiography to assess for ICR, defined as an improvement in contractility in more than five of 16 left ventricular segments. Results: During a mean follow-up period of 206 ± 167 days, 31 patients (57%) were responders, as defined by a 5-point increase in ejection fraction after CRT. The presence of ICR was a stronger predictor of response to CRT (area under the curve, 0.94; χ2 = 39.0; P < .0001) compared with dyssynchrony (area under the curve, 0.74; χ2 = 10.07; P = .002). It was a significant predictor of response (odds ratio, 2.84; 95% confidence interval, 1.59 to 5.09; P < .0001), even after controlling for the other predictors, and provided incremental prognostic value beyond that provided by QRS duration and dyssynchrony (increase in area under the curve from 0.47 to 0.75 to 0.93; P = .030 and P = .008). Conclusions: In patients referred for CRT, ICR was a stronger predictor of response and provided incremental value beyond that of current known predictors of response to CRT (dyssynchrony and QRS duration). Dobutamine stress echocardiography may have an important role in identifying CRT responders, and further multicenter studies are needed to confirm this.

KW - Cardiac resynchronization therapy

KW - Dobutamine

KW - Dyssynchrony

KW - Echocardiography

KW - Inotropic contractile reserve

KW - Stress

UR - http://www.scopus.com/inward/record.url?scp=78650515023&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78650515023&partnerID=8YFLogxK

U2 - 10.1016/j.echo.2010.10.007

DO - 10.1016/j.echo.2010.10.007

M3 - Article

VL - 24

SP - 91

EP - 97

JO - Journal of the American Society of Echocardiography

JF - Journal of the American Society of Echocardiography

SN - 0894-7317

IS - 1

ER -