Dobutamine-induced mechanical alternans is a marker of poor prognosis in idiopathic dilated cardiomyopathy

Akihiro Hirashiki, Hideo Izawa, Xian Wu Cheng, Kazumasa Unno, Satoru Ohshima, Toyoaki Murohara

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Summary 1. To date, few prognostic indicators for ambulatory patients with idiopathic dilated cardiomyopathy (IDCM) have been identified. The purpose of the present study was to investigate the relationship between the occurrence of dobutamine-induced mechanical alternans (MA) and prognosis in ambulatory patients with IDCM. 2. Left ventricular pressure was measured during right atrial pacing and after intravenous infusion of dobutamine at incremental doses in 90 ambulatory patients with IDCM in sinus rhythm. Endomyocardial biopsy specimens were also obtained for quantitative analysis of gene expression. The patients were followed up for a mean of 2.5 years. 3. Patients were classified into three groups: (i) 60 patients who exhibited neither pacing- nor dobutamine-induced MA (Group N); (ii) 20 patients who manifested only pacing-induced MA (Group P); and (iii) 10 patients who developed both pacing- and dobutamine-induced MA (Group D). The sarcoplasmicendoplasmic reticulum calcium ATPase 2a : phospholamban mRNA ratio was significantly higher in Group D patients than in patients in Groups N or P. Multivariate analysis revealed that dobutamine-induced MA (odds ratio 4.05; 95% confidence interval 1.35-12.2) was a significant independent predictor of cardiac events. Cardiac event-free survival in Group D was significantly lower than in Groups N or P, as determined by Kaplan-Meier analysis (P = 0.002). 4. The occurrence of dobutamine-induced MA is a potentially useful clinical predictor of poor prognosis in ambulatory patients with IDCM in sinus rhythm.

Original languageEnglish
Pages (from-to)1004-1009
Number of pages6
JournalClinical and Experimental Pharmacology and Physiology
Volume37
Issue number10
DOIs
Publication statusPublished - 01-10-2010

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Dobutamine
Dilated Cardiomyopathy
Reticulum
Calcium-Transporting ATPases
Kaplan-Meier Estimate
Ventricular Pressure
Intravenous Infusions
Disease-Free Survival
Multivariate Analysis
Odds Ratio
Confidence Intervals
Biopsy
Gene Expression

All Science Journal Classification (ASJC) codes

  • Physiology
  • Pharmacology
  • Physiology (medical)

Cite this

Hirashiki, Akihiro ; Izawa, Hideo ; Cheng, Xian Wu ; Unno, Kazumasa ; Ohshima, Satoru ; Murohara, Toyoaki. / Dobutamine-induced mechanical alternans is a marker of poor prognosis in idiopathic dilated cardiomyopathy. In: Clinical and Experimental Pharmacology and Physiology. 2010 ; Vol. 37, No. 10. pp. 1004-1009.
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Dobutamine-induced mechanical alternans is a marker of poor prognosis in idiopathic dilated cardiomyopathy. / Hirashiki, Akihiro; Izawa, Hideo; Cheng, Xian Wu; Unno, Kazumasa; Ohshima, Satoru; Murohara, Toyoaki.

In: Clinical and Experimental Pharmacology and Physiology, Vol. 37, No. 10, 01.10.2010, p. 1004-1009.

Research output: Contribution to journalArticle

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AU - Izawa, Hideo

AU - Cheng, Xian Wu

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N2 - Summary 1. To date, few prognostic indicators for ambulatory patients with idiopathic dilated cardiomyopathy (IDCM) have been identified. The purpose of the present study was to investigate the relationship between the occurrence of dobutamine-induced mechanical alternans (MA) and prognosis in ambulatory patients with IDCM. 2. Left ventricular pressure was measured during right atrial pacing and after intravenous infusion of dobutamine at incremental doses in 90 ambulatory patients with IDCM in sinus rhythm. Endomyocardial biopsy specimens were also obtained for quantitative analysis of gene expression. The patients were followed up for a mean of 2.5 years. 3. Patients were classified into three groups: (i) 60 patients who exhibited neither pacing- nor dobutamine-induced MA (Group N); (ii) 20 patients who manifested only pacing-induced MA (Group P); and (iii) 10 patients who developed both pacing- and dobutamine-induced MA (Group D). The sarcoplasmicendoplasmic reticulum calcium ATPase 2a : phospholamban mRNA ratio was significantly higher in Group D patients than in patients in Groups N or P. Multivariate analysis revealed that dobutamine-induced MA (odds ratio 4.05; 95% confidence interval 1.35-12.2) was a significant independent predictor of cardiac events. Cardiac event-free survival in Group D was significantly lower than in Groups N or P, as determined by Kaplan-Meier analysis (P = 0.002). 4. The occurrence of dobutamine-induced MA is a potentially useful clinical predictor of poor prognosis in ambulatory patients with IDCM in sinus rhythm.

AB - Summary 1. To date, few prognostic indicators for ambulatory patients with idiopathic dilated cardiomyopathy (IDCM) have been identified. The purpose of the present study was to investigate the relationship between the occurrence of dobutamine-induced mechanical alternans (MA) and prognosis in ambulatory patients with IDCM. 2. Left ventricular pressure was measured during right atrial pacing and after intravenous infusion of dobutamine at incremental doses in 90 ambulatory patients with IDCM in sinus rhythm. Endomyocardial biopsy specimens were also obtained for quantitative analysis of gene expression. The patients were followed up for a mean of 2.5 years. 3. Patients were classified into three groups: (i) 60 patients who exhibited neither pacing- nor dobutamine-induced MA (Group N); (ii) 20 patients who manifested only pacing-induced MA (Group P); and (iii) 10 patients who developed both pacing- and dobutamine-induced MA (Group D). The sarcoplasmicendoplasmic reticulum calcium ATPase 2a : phospholamban mRNA ratio was significantly higher in Group D patients than in patients in Groups N or P. Multivariate analysis revealed that dobutamine-induced MA (odds ratio 4.05; 95% confidence interval 1.35-12.2) was a significant independent predictor of cardiac events. Cardiac event-free survival in Group D was significantly lower than in Groups N or P, as determined by Kaplan-Meier analysis (P = 0.002). 4. The occurrence of dobutamine-induced MA is a potentially useful clinical predictor of poor prognosis in ambulatory patients with IDCM in sinus rhythm.

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