Feasibility of semi-quantitative assessment of left ventricular contractile reserve in dilated cardiomyopathy

✍ Scribed by Petar Otasevic; Nebojsa Tasic; Radoslav Vidakovic; Srdjan Boskovic; Djordje Radak; Bosko Djukanovic; Lazar Angelkov; Nada Kostic; Zorica Caparevic; Zorana Vasiljevic-Pokrajcic

• Publisher: John Wiley and Sons
• Year: 2012
• Tongue: English
• Weight: 922 KB
• Volume: 40
• Category: Article
• ISSN: 0091-2751
• DOI: 10.1002/jcu.21903

✦ Synopsis

Abstract

Background:

We and others have shown previously that left ventricular (LV) contractile reserve assessed quantitatively by high‐dose dobutamine stress‐echocardiography (DSE) has prognostic implications in patients with dilated cardiomyopathy.

Purpose:

To assess the feasibility of semi‐quantitative assessment of LV contractile reserve by differently skilled operators in patients with dilated cardiomyopathy.

Methods:

High‐dose DSE was performed in 63 consecutive patients, mean age 50 ± 10 years and ejection fraction (EF) 19 ± 8%. LVEF was calculated 1) using Simpson's biplane formula, and 2) semi‐quantitatively (5% increments) by novice and experienced echocardiographers, and by a DSE expert. Patients were considered to have preserved LV contractile reserve if LVEF dobutamine‐induced change was ≥5%.

Results:

Twenty‐seven (45.8%) patients died during the 5‐year follow‐up. The feasibility of the assessment was 89%, 94%, and 98% for novice and experienced readers and DSE expert, respectively. Kaplan‐Meier analysis showed that LV contractile reserve assessed semi‐quantitatively by DSE expert and experienced reader achieved the best prognostic separation (log rank 19.63 and 18.99, respectively, p < 0.001 for both), followed by quantitative assessment (log rank 9.76, p = 0.0018) and assessment by novice reader (log rank 8.76, p = 0.012). Areas under the curves were similar for quantitative and semi‐quantitative assessment of LV contractile reserve.

Conclusions:

Our data indicate that semi‐quantitative assessment of LV contractile reserve is feasible by differently skilled operators. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:405–409, 2012