Inotropic Contractile Reserve Can Risk-Stratify Patients With HIV Cardiomyopathy A Dobutamine Stress Echocardiography Study

JACC-CARDIOVASCULAR IMAGING

卷:4

Article

Wever-Pinzon, Omar²  Bangalore, Sripal³  Romero, Jorge²  Enciso, Jorge Silva²  Chaudhry, Farooq A.^1,2 

[1] Columbia Univ, St Lukes Roosevelt Hosp Ctr, Div Cardiol, New York, NY 10025 USA

[2] Columbia Univ, Coll Phys & Surg, New York, NY 10025 USA

[3] NYU, Sch Med, New York, NY USA

关键词: cardiomyopathy;    dobutamine stress echo;    human immunodeficiency virus;    inotropic contractile reserve;   

DOI  :  10.1016/j.jcmg.2011.09.012

来源: Elsevier

【 摘 要 】

OBJECTIVES The purpose of this study was to assess whether inotropic contractile reserve (ICR) during dobutamine stress echocardiography (DSE) could risk-stratify patients with human immunodeficiency virus (HIV) cardiomyopathy and predict improvement of left ventricular ejection fraction (LVEF). BACKGROUND HIV cardiomyopathy is an important cause of heart failure and death. ICR is associated with better survival and improvement of LVEF in patients with ischemic and nonischemic cardiomyopathies. However, the prognostic value of ICR in patients with HIV cardiomyopathy is unknown. METHODS Patients with HIV cardiomyopathy and a LVEF <45% who were referred for DSE were enrolled. ICR was evaluated by the delta wall motion score index (Delta WMSI), calculated as the difference between rest and peak WMSI. Patients were followed for cardiac death and change in LVEF on follow-up. RESULTS Sixty patients (75% men; age, 54 +/- 9 years) with HIV cardiomyopathy (mean LVEF, 28 +/- 11%) formed the study group. After 2.4 +/- 2.1 years, 11 cardiac deaths occurred (event rate of 7.6%/year). A receiver-operating characteristic curve identified a Delta WMSI of 0.38 as an optimal cut point for the presence of ICR, with a specificity of 88% and a sensitivity of 73% for the prediction of cardiac death. On univariable analysis, the absence of ICR (hazard ratio: 6.6; 95% confidence interval: 1.93 to 22.62; p = 0.003) and New York Heart Association functional class IV (hazard ratio: 7.2; 95% confidence interval: 2.20 to 23.65; p = 0.001) were the only predictors of cardiac death. After 2.1 +/- 1.8 years, 41 patients had a follow-up echocardiogram. LVEF improvement from baseline occurred in 23 patients (56%), more so in patients with ICR than without ICR. A Delta WMSI of 0.59 predicted improvement in the LVEF with a specificity of 78% and a sensitivity of 74%. CONCLUSIONS The presence of ICR during DSE can risk-stratify and predict subsequent improvement in LVEF in patients with HIV cardiomyopathy. (J Am Coll Cardiol Img 2011;4:1231-8) (C) 2011 by the American College of Cardiology Foundation

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