Key result
Dipyridamole-induced contractile reserve yielded significant incremental prognostic value for cardiac death in patients with dilated cardiomyopathy (RR 0.275; p<0.006).
Why the study?
Does the combination of restrictive transmitral flow pattern and lack of dipyridamole-induced contractile reserve predict cardiac death in patients with dilated cardiomyopathy?
Cohort (n=116)
Does the combination of restrictive transmitral flow pattern and lack of dipyridamole-induced contractile reserve predict cardiac death in patients with dilated cardiomyopathy?
Relative Risk: 0.275
p-value: p=<0.006
The combination of a restrictive transmitral flow pattern at rest and a lack of contractile reserve during dipyridamole stress is a strong predictor of cardiac death in patients with dilated cardiomyopathy.
May refine risk stratification in dilated cardiomyopathy; hypothesis-generating and requires prospective validation before clinical adoption.
BACKGROUND: Diastolic dysfunction and lack of contractile reserve are unfavorable prognostic predictors in patients with dilated cardiomyopathy (DCM). AIMS: This study aims to assess whether diastolic dysfunction and lack of dipyridamole-induced contractile reserve were additive predictors of poor outcome in patients with DCM. METHODS: A total of 116 patients with DCM and ejection fraction (EF<35%) were studied by dipyridamole echo (0.84 mg/kg over 10 min). At rest, a restrictive filling pattern was defined as: E/A ratio >2 and an E-wave deceleration time of <140 ms on transmitral flow velocity profile. RESULTS: Rest wall motion score index (WMSI) was 2.2+/-0.3 and decreased to 1.9+/-0.41 after dipyridamole (p<0.001). During follow-up (median 26.5 months), 22 cardiac deaths occurred. At multivariate analysis, dipyridamole-induced contractile reserve yielded significant incremental prognostic value (RR=0.275, p<0.006) over NYHA class (RR=1.971, p<0.03), angiotensin-converting enzyme inhibitor therapy (RR=0.173, p<0.001), and left ventricular end-diastolic diameter (RR=1.131, p<0.001). The worst prognostic combination was the presence of restrictive pattern at rest and the absence of contractile reserve (deltaWMSI<0.15). CONCLUSION: In patients with DCM, the ominous combination of restrictive transmitral flow pattern and lack of contractile reserve during dipyridamole stress predicts an unfavourable outcome.
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Pratali et al. (2005) conducted a cohort in Idiopathic Dilated Cardiomyopathy (n=116). Dipyridamole-induced contractile reserve vs. Lack of contractile reserve was evaluated on Cardiac death (RR 0.275, p=<0.006). Dipyridamole-induced contractile reserve yielded significant incremental prognostic value for cardiac death in patients with dilated cardiomyopathy (RR 0.275; p<0.006).
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