BACKGROUND: In chronic heart failure augmented wall stress leads to increased energy demand. Supply, however, may be reduced due to coronary vasoconstriction and endothelial dysfunction. This might lead to a mismatch between demand and supply. In the present study we further explored the effect of increased demand during dobutamine stress echocardiography. METHODS AND RESULTS: Sixteen patients with idiopathic dilated cardiomyopathy (mean age 44+/-13 years, New York Heart Association class II-III, mean left ventricular ejection fraction 0.27+/-0.10) underwent dobutamine stress echocardiography (5-40 microg/min per kg bodyweight+atropine if required). Wall motion and thickening was assessed in 16 segments using a four-point scale. Eleven patients (69%) showed regions with worsening of wall motion or a biphasic response during dobutamine infusion. Of the remaining five patients one patient did not show any wall motion changes and one patient showed a partial improvement while only in three patients wall motion improvement in the whole heart was found. CONCLUSION: A majority of patients with idiopathic dilated cardiomyopathy showed decreased wall motion during increased demand, i.e. ischemia-like myocardial contractile responses during dobutamine stress echocardiography. These findings further support the concept that an energy mismatch between demand and supply might play a pathophysiological role in idiopathic dilated cardiomyopathy.
BACKGROUND: In chronic heart failure augmented wall stress leads to increased energy demand. Supply, however, may be reduced due to coronary vasoconstriction and endothelial dysfunction. This might lead to a mismatch between demand and supply. In the present study we further explored the effect of increased demand during dobutamine stress echocardiography. METHODS AND RESULTS: Sixteen patients with idiopathic dilated cardiomyopathy (mean age 44+/-13 years, New York Heart Association class II-III, mean left ventricular ejection fraction 0.27+/-0.10) underwent dobutamine stress echocardiography (5-40 microg/min per kg bodyweight+atropine if required). Wall motion and thickening was assessed in 16 segments using a four-point scale. Eleven patients (69%) showed regions with worsening of wall motion or a biphasic response during dobutamine infusion. Of the remaining five patients one patient did not show any wall motion changes and one patient showed a partial improvement while only in three patients wall motion improvement in the whole heart was found. CONCLUSION: A majority of patients with idiopathic dilated cardiomyopathy showed decreased wall motion during increased demand, i.e. ischemia-like myocardial contractile responses during dobutamine stress echocardiography. These findings further support the concept that an energy mismatch between demand and supply might play a pathophysiological role in idiopathic dilated cardiomyopathy.
Authors: Richard M de Jong; Antoon T M Willemsen; Riemer H J A Slart; Paul K Blanksma; Aren van Waarde; Jan Hein Cornel; Willem Vaalburg; Dirk J van Veldhuisen; Philip H Elsinga Journal: Eur J Nucl Med Mol Imaging Date: 2004-12-11 Impact factor: 9.236
Authors: R A Tio; R H J A Slart; R A de Boer; P A van der Vleuten; R M de Jong; L M van Wijk; T Willems; D D Lubbers; A A Voors; D J van Veldhuisen Journal: Neth Heart J Date: 2009-12 Impact factor: 2.380
Authors: R H J A Slart; R A Tio; P A van der Vleuten; T P Willems; D D Lubbers; R A Dierckx; D J van Veldhuisen Journal: J Nucl Cardiol Date: 2010-03-18 Impact factor: 5.952
Authors: Richard M de Jong; Rene A Tio; Pim van der Harst; Adriaan A Voors; Paul M Koning; Clark J A M Zeebregts; Dirk J van Veldhuisen; Rudi A J O Dierckx; Riemer H J A Slart Journal: J Nucl Cardiol Date: 2009-08-01 Impact factor: 5.952