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Left atrial systolic reserve in idiopathic vs. ischaemic‐dilated cardiomyopathy
Author(s) -
Moyssakis I.,
Papadopoulos D. P.,
Kelepeshis G.,
Gialafos E.,
Votteas V.,
Triposkiadis F.
Publication year - 2005
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/j.1365-2362.2005.01505.x
Subject(s) - medicine , cardiology , systole , dobutamine , dilated cardiomyopathy , cardiomyopathy , mitral valve , ejection fraction , heart failure , hemodynamics , diastole , blood pressure
Purpose There are studies indicating more pronounced left atrial (LA) systolic dysfunction at rest in idiopathic (IDDC) than in ischaemic‐dilated cardiomyopathy (ISDC). It was hypothesized that the findings would be similar with regards LA systolic reserve. Methods Twenty‐six patients with IDDC, 28 with ISDC and 25 normal controls underwent low‐dose dobutamine stress echocardiography (5–10 µg kg −1 min −1 IV). Left atrial volumes were echocardiographically determined at rest and during stress at the mitral valve opening (maximal, Vmax), electrocardiographic P wave (onset of atrial systole, Vp) and mitral valve closure (minimal, Vmin) from the apical 4‐ and 2‐chamber views (biplane area‐length method). Left atrial systolic function was assessed with the LA‐active emptying volume (ACTEV) = Vp‐Vmin and fraction (ACTEF) = ACTEV/Vp. Results Vmax at rest was similar in IDDC and ISDC and greater than in the controls (54·2 ± 12 vs. 48·5 ± 18 vs. 27·1 ± 6·3 cm 3 m −2 , respectively, P < 0·001) and did not change with stress (53·9 ± 13·8 vs. 46·9 ± 16·2 vs. 25·8 ± 5·9 cm 3 m −2 , P < 0·001). The ACTEV at rest was similar in IDDC and ISDC and greater than in the controls (8·6 ± 3·5 vs. 9·7 ± 2·9 vs. 6·1 ± 2·2 cm 3 m −2 P < 0·01), whereas during the dobutamine infusion it remained unaltered in IDDC (10·8 ± 4·6 cm 3 m −2 , P = NS vs. rest) and increased in ISDC (11·8 ± 3·3 cm 3 m −2 , P < 0·05) and the controls (13·1 ± 3·2 cm 3 m −2 , P < 0·01). The ACTEF was lower in IDDC than ISDC and the controls at rest (20 ± 10% vs. 33 ± 8% vs. 36 ± 10%, P < 0·01). Dobutamine infusion was associated with no significant increase in ACTEF in IDDC (25 ± 12%, P = NS vs. rest), and with an increase in this variable in ISDC (39 ± 10%, P < 0·05) and the controls (49 ± 12%, P < 0·01). Conclusions Dobutamine infusion is associated with an increase in LA ACTEV and fraction in ISDC and no significant change in these indices in IDDC. These findings indicate a reduced LA systolic reserve in IDDC.