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NT‐proBNP response to dobutamine stress echocardiography predicts left ventricular contractile reserve in dilated cardiomyopathy
Author(s) -
Parthenakis Frangiskos I.,
Patrianakos Alexandros P.,
Haritakis Costas N.,
Zacharis Evangelos A.,
Nyktari Eva G.,
Vardas Panos E.
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.03.003
Subject(s) - dobutamine , medicine , inotrope , cardiology , heart failure , contractility , dilated cardiomyopathy , natriuretic peptide , ejection fraction , cardiomyopathy , hemodynamics
Background: Brain natriuretic peptide (BNP) and left ventricular (LV) inotropic reserve are major prognostic indexes in heart failure (HF). Aims: To investigate the relationship between N‐terminal‐proBNP (NT‐proBNP) changes in response to dobutamine stress echocardiography (DSE) and the LV inotropic reserve, in HF patients with dilated cardiomyopathy (DC). Methods: We studied 41 patients with DC, LVEF 31.6±7.7%, NYHA class II–III and 15 controls. Plasma NT‐proBNP levels were measured before and 60 min after three 5‐min stages of dobutamine (5 to 15μg/kg/min). Results: Based on NT‐proBNP changes in response to dobutamine, patients were categorized into two groups: In Group A circulating NT‐proBNP levels fell (−16.6 ± 7.8%), and in Group B they increased (8.4±9.1%). Group A had a marked improvement in WMSI compared to Group B (32.1±9.7% vs. 18.8±15.9%, p <0.001). Multivariate analysis showed that NT‐proBNP changes were an independent predictor of LV inotropic reserve ( b =−0.55, p <0.001). A reduction of 21.3% in plasma NT‐proBNP levels in response to dobutamine predicted an improvement in WMSI of >25% with a sensitivity of 100% and a specificity of 92.3%. Conclusions: NT‐proBNP changes in response to dobutamine reflect improvement in LV contractility and constitute an independent predictor of LV inotropic reserve in patients with DC.