Key result
Preserved myocardial contractile function in segments attached to the papillary muscles predicted dobutamine-induced ≥20% reduction in mitral valve tenting (AUC 0.67, P<0.05).
Why the study?
Does regional myocardial contractile function predict dobutamine-induced reduction in functional mitral regurgitation in patients with dilated cardiomyopathy and depressed LVEF?
Observational (n=51)
Does regional myocardial contractile function predict dobutamine-induced reduction in functional mitral regurgitation in patients with dilated cardiomyopathy and depressed LVEF?
Effect estimate: AUC 0.67
p-value: p=<0.05
Preserved myocardial contractile function in segments attached to papillary muscles predicts dobutamine-induced reduction in functional mitral regurgitation and valve tenting.
May identify dobutamine responders in functional MR; hypothesis-generating for contractile assessment in dilated cardiomyopathy.
BACKGROUND: Effectiveness of functional mitral regurgitation (FMR) in heart failure patients is of growing importance for patient prognosis. The purpose of this study was to investigate whether regional myocardial contractile function as assessed by tissue Doppler strain rate imaging can predict reduction in FMR caused by dobutamine. METHODS: Fifty-one patients with depressed left ventricular (LV) ejection fraction (32 ± 9%) secondary to dilated cardiomyopathy and FMR underwent evaluation of effective regurgitant orifice (ERO) of FMR, mitral valve deformation, global LV remodeling, and regional myocardial contractile function assessed by longitudinal peak systolic strain rate (Ssr) in 6 mid-LV segments from standard apical views. We also determined the average Ssr of segments attached to the papillary muscles, that is, the inferior, inferolateral, and anterolateral segments (PM segments Ssr). Low-dose (10 μg/kg per minute) dobutamine-induced reduction in ERO was compared with baseline variables. RESULTS: Baseline valve tenting was associated with dobutamine-induced reduction in ERO (r = -0.30, P < 0.05). Receiver operating characteristic curve analysis showed that baseline valve tenting, LV sphericity index, inferior Ssr, inferolateral Ssr, and PM segments Ssr were predictors of dobutamine-induced ≥30% reduction in ERO. Importantly, only PM segments Ssr predicted dobutamine-induced ≥20% reduction in valve tenting with area under the curve of 0.67 (P < 0.05). CONCLUSIONS: Preserved myocardial contractile function in the segments attached to the PMs was associated with dobutamine-induced reduction in mitral valve tenting and FMR, suggesting that our findings are important for improvement in cardiac function and FMR with medical treatment.
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Tatsumi et al. (2012) conducted an observational in Depressed left ventricular ejection fraction secondary to dilated cardiomyopathy and functional mitral regurgitation (n=51). Dobutamine was evaluated on Dobutamine-induced ≥30% reduction in effective regurgitant orifice and ≥20% reduction in valve tenting (AUC 0.67, p=<0.05). Preserved myocardial contractile function in segments attached to the papillary muscles predicted dobutamine-induced ≥20% reduction in mitral valve tenting (AUC 0.67, P<0.05).