TY - JOUR
T1 - Myocardial Contractile Reserve by Dobutamine Stress Echocardiography Predicts Improvement in Ejection Fraction with β-Blockade in Patients with Heart Failure
T2 - The β-Blocker Evaluation of Survival Trial (BEST)
AU - Eichhorn, Eric J.
AU - Grayburn, Paul A.
AU - Mayer, Susan A.
AU - Sutton, Martin St John
AU - Appleton, Christopher
AU - Plehn, Jonathan
AU - Oh, Jae
AU - Greenberg, Barry
AU - DeMaria, Anthony
AU - Frantz, Robert
AU - Krause-Steinrauf, Heidi
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2003/11/11
Y1 - 2003/11/11
N2 - Background - β-Blockers improve survival and reduce hospitalization in chronic heart failure (CHF) by biologically improving left ventricular ejection fraction (LVEF). However, a good predictor of improvement with this therapy has not been identified. This substudy of BEST examined whether myocardial contractile reserve, as determined by dobutamine stress echocardiography, predicts improvement in LVEF. Methods and Results - Seventy-nine patients with class III/IV CHF underwent dobutamine stress echocardiography before treatment with bucindolol (n =41) or placebo (n = 38). Regional wall motion score index (WMSI) was calculated as the sum of the scores in each segment divided by the total number of segments visualized. WMSI was compared with change in LVEF after 3 months of therapy as determined by gated radionuclide scan. Change in WMSI correlated inversely with change in LVEF after 3 months of bucindolol (r=-0.72, P<0.0001) and was the most significant multivariate predictor of change in LVEF (P=0.0002). Patients with contractile reserve had demographics similar to those of patients without contractile reserve, including RVEF, LVEF, systolic blood pressure, and CHF duration. However, patients without contractile reserve had higher baseline plasma norepinephrine levels (687±333 versus 420±246 pg/mL, P<0.05) and greater decrease in plasma norepinephrine in response to bucindolol (-249±171 versus -35±277 pg/mL, P<0.05). Conclusions - This study suggests a direct relationship between contractile reserve and improvement in LVEF with β-blocker therapy in patients with advanced CHF. Patients without contractile reserve have higher resting adrenergic drive, as reflected by plasma norepinephrine, and may experience greater sympatholytic effects from bucindolol.
AB - Background - β-Blockers improve survival and reduce hospitalization in chronic heart failure (CHF) by biologically improving left ventricular ejection fraction (LVEF). However, a good predictor of improvement with this therapy has not been identified. This substudy of BEST examined whether myocardial contractile reserve, as determined by dobutamine stress echocardiography, predicts improvement in LVEF. Methods and Results - Seventy-nine patients with class III/IV CHF underwent dobutamine stress echocardiography before treatment with bucindolol (n =41) or placebo (n = 38). Regional wall motion score index (WMSI) was calculated as the sum of the scores in each segment divided by the total number of segments visualized. WMSI was compared with change in LVEF after 3 months of therapy as determined by gated radionuclide scan. Change in WMSI correlated inversely with change in LVEF after 3 months of bucindolol (r=-0.72, P<0.0001) and was the most significant multivariate predictor of change in LVEF (P=0.0002). Patients with contractile reserve had demographics similar to those of patients without contractile reserve, including RVEF, LVEF, systolic blood pressure, and CHF duration. However, patients without contractile reserve had higher baseline plasma norepinephrine levels (687±333 versus 420±246 pg/mL, P<0.05) and greater decrease in plasma norepinephrine in response to bucindolol (-249±171 versus -35±277 pg/mL, P<0.05). Conclusions - This study suggests a direct relationship between contractile reserve and improvement in LVEF with β-blocker therapy in patients with advanced CHF. Patients without contractile reserve have higher resting adrenergic drive, as reflected by plasma norepinephrine, and may experience greater sympatholytic effects from bucindolol.
KW - Bucindolol
KW - Contractility
KW - Heart failure
KW - Norepinephrine
KW - Receptors, adrenergic, beta
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U2 - 10.1161/01.CIR.0000097111.00170.7B
DO - 10.1161/01.CIR.0000097111.00170.7B
M3 - Article
C2 - 14597587
AN - SCOPUS:0242442134
SN - 0009-7322
VL - 108
SP - 2336
EP - 2341
JO - Circulation
JF - Circulation
IS - 19
ER -