Inotropic contractile reserve can risk-stratify patients with HIV cardiomyopathy: A dobutamine stress echocardiography study

Omar Wever-Pinzon, Sripal Bangalore, Jorge E. Romero, Jorge Silva Enciso, Farooq A. Chaudhry

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

The purpose of this study was to assess whether inotropic contractile reserve (ICR) during dobutamine stress echocardiography (DSE) could risk-stratify patients with human immunodeficiency virus (HIV) cardiomyopathy and predict improvement of left ventricular ejection fraction (LVEF). HIV cardiomyopathy is an important cause of heart failure and death. ICR is associated with better survival and improvement of LVEF in patients with ischemic and nonischemic cardiomyopathies. However, the prognostic value of ICR in patients with HIV cardiomyopathy is unknown. Patients with HIV cardiomyopathy and a LVEF <45% who were referred for DSE were enrolled. ICR was evaluated by the delta wall motion score index (ΔWMSI), calculated as the difference between rest and peak WMSI. Patients were followed for cardiac death and change in LVEF on follow-up. Sixty patients (75% men; age, 54 ± 9 years) with HIV cardiomyopathy (mean LVEF, 28 ± 11%) formed the study group. After 2.4 ± 2.1 years, 11 cardiac deaths occurred (event rate of 7.6%/year). A receiver-operating characteristic curve identified a ΔWMSI of 0.38 as an optimal cut point for the presence of ICR, with a specificity of 88% and a sensitivity of 73% for the prediction of cardiac death. On univariable analysis, the absence of ICR (hazard ratio: 6.6; 95% confidence interval: 1.93 to 22.62; p = 0.003) and New York Heart Association functional class IV (hazard ratio: 7.2; 95% confidence interval: 2.20 to 23.65; p = 0.001) were the only predictors of cardiac death. After 2.1 ± 1.8 years, 41 patients had a follow-up echocardiogram. LVEF improvement from baseline occurred in 23 patients (56%), more so in patients with ICR than without ICR. A ΔWMSI of 0.59 predicted improvement in the LVEF with a specificity of 78% and a sensitivity of 74%. The presence of ICR during DSE can risk-stratify and predict subsequent improvement in LVEF in patients with HIV cardiomyopathy.

Original languageEnglish (US)
Pages (from-to)1231-1238
Number of pages8
JournalJACC: Cardiovascular Imaging
Volume4
Issue number12
DOIs
StatePublished - Dec 2011
Externally publishedYes

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Stress Echocardiography
Cardiomyopathies
Stroke Volume
HIV
Confidence Intervals
ROC Curve
Heart Failure

Keywords

  • cardiomyopathy
  • dobutamine stress echo
  • human immunodeficiency virus
  • inotropic contractile reserve

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Inotropic contractile reserve can risk-stratify patients with HIV cardiomyopathy : A dobutamine stress echocardiography study. / Wever-Pinzon, Omar; Bangalore, Sripal; Romero, Jorge E.; Silva Enciso, Jorge; Chaudhry, Farooq A.

In: JACC: Cardiovascular Imaging, Vol. 4, No. 12, 12.2011, p. 1231-1238.

Research output: Contribution to journalArticle

Wever-Pinzon, Omar ; Bangalore, Sripal ; Romero, Jorge E. ; Silva Enciso, Jorge ; Chaudhry, Farooq A. / Inotropic contractile reserve can risk-stratify patients with HIV cardiomyopathy : A dobutamine stress echocardiography study. In: JACC: Cardiovascular Imaging. 2011 ; Vol. 4, No. 12. pp. 1231-1238.
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