Dobutamine Stress Testing as a Diagnostic Tool for Evaluation of Myocardial Contractile Reserve in Asymptomatic or Mildly Symptomatic Patients With Dilated Cardiomyopathy

Masakazu Kobayashi, Hideo Izawa, Xian Wu Cheng, Hiroyuki Asano, Akihiro Hirashiki, Kazumasa Unno, Satoru Ohshima, Takashi Yamada, Yosuke Murase, Tomoko S. Kato, Koji Obata, Akiko Noda, Takao Nishizawa, Satoshi Isobe, Kohzo Nagata, Tatsuaki Matsubara, Toyoaki Murohara, Mitsuhiro Yokota

Research output: Contribution to journalArticle

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Abstract

Objectives: We performed dobutamine stress testing for evaluation of myocardial contractile reserve in asymptomatic or mildly symptomatic patients with dilated cardiomyopathy (DCM). Background: Catecholamine sensitivity is reduced in failing hearts as a result of myocardial abnormalities in the beta-adrenergic receptor signaling pathway. However, little is known about adrenergic myocardial contractile reserve in asymptomatic or mildly symptomatic patients with DCM. Methods: The maximal first derivative of left ventricular pressure (LV dP/dtmax) was determined during infusion of dobutamine (10 μg kg-1 min-1) in 46 asymptomatic or mildly symptomatic (New York Heart Association functional class I or II) patients with DCM. The expression of messenger ribonucleic acid (mRNA) for contractile regulatory proteins in endomyocardial biopsy specimens was quantified by reverse transcription and real-time polymerase chain reaction analysis. Plasma norepinephrine levels were measured in all patients and [123I]metaiodobenzylguanidine (MIBG) scintigraphy performed. Results: Patients were classified into 3 groups based on the percentage increase in LV dP/dtmax induced by dobutamine (ΔLV dP/dtmax) and on LV ejection fraction (LVEF) at baseline: group I (n = 18): ΔLV dP/dtmax >100% and LVEF >25%; group IIa (n = 17): ΔLV dP/dtmax ≤100% and LVEF > 25%; and group IIb (n = 11): ΔLV dP/dtmax ≤100% and LVEF ≤25%. The amounts of beta1-adrenergic receptor, sarcoplasmic reticulum Ca2+-adenosine triphosphatase, and phospholamban mRNA were significantly smaller in groups IIa and IIb than in group I. The plasma norepinephrine level was increased and the delayed heart/mediastinum count ratio in MIBG scintigraphy was decreased in both groups IIa and IIb. Conclusions: Dobutamine stress testing is a useful diagnostic tool for identifying reduced adrenergic myocardial contractile reserve related to altered myocardial expression of beta1-adrenergic receptor, sarcoplasmic reticulum Ca2+-adenosine triphosphatase, and phospholamban genes even in asymptomatic or mildly symptomatic patients with DCM.

Original languageEnglish
Pages (from-to)718-726
Number of pages9
JournalJACC: Cardiovascular Imaging
Volume1
Issue number6
DOIs
Publication statusPublished - 01-11-2008
Externally publishedYes

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Dobutamine
Dilated Cardiomyopathy
Sarcoplasmic Reticulum
Radionuclide Imaging
Adrenergic Agents
Adrenergic Receptors
Adenosine Triphosphatases
Norepinephrine
RNA
Contractile Proteins
Receptors, Adrenergic, beta
Mediastinum
Ventricular Pressure
Reverse Transcription
Catecholamines
Real-Time Polymerase Chain Reaction
Biopsy
Genes

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Kobayashi, Masakazu ; Izawa, Hideo ; Cheng, Xian Wu ; Asano, Hiroyuki ; Hirashiki, Akihiro ; Unno, Kazumasa ; Ohshima, Satoru ; Yamada, Takashi ; Murase, Yosuke ; Kato, Tomoko S. ; Obata, Koji ; Noda, Akiko ; Nishizawa, Takao ; Isobe, Satoshi ; Nagata, Kohzo ; Matsubara, Tatsuaki ; Murohara, Toyoaki ; Yokota, Mitsuhiro. / Dobutamine Stress Testing as a Diagnostic Tool for Evaluation of Myocardial Contractile Reserve in Asymptomatic or Mildly Symptomatic Patients With Dilated Cardiomyopathy. In: JACC: Cardiovascular Imaging. 2008 ; Vol. 1, No. 6. pp. 718-726.
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abstract = "Objectives: We performed dobutamine stress testing for evaluation of myocardial contractile reserve in asymptomatic or mildly symptomatic patients with dilated cardiomyopathy (DCM). Background: Catecholamine sensitivity is reduced in failing hearts as a result of myocardial abnormalities in the beta-adrenergic receptor signaling pathway. However, little is known about adrenergic myocardial contractile reserve in asymptomatic or mildly symptomatic patients with DCM. Methods: The maximal first derivative of left ventricular pressure (LV dP/dtmax) was determined during infusion of dobutamine (10 μg kg-1 min-1) in 46 asymptomatic or mildly symptomatic (New York Heart Association functional class I or II) patients with DCM. The expression of messenger ribonucleic acid (mRNA) for contractile regulatory proteins in endomyocardial biopsy specimens was quantified by reverse transcription and real-time polymerase chain reaction analysis. Plasma norepinephrine levels were measured in all patients and [123I]metaiodobenzylguanidine (MIBG) scintigraphy performed. Results: Patients were classified into 3 groups based on the percentage increase in LV dP/dtmax induced by dobutamine (ΔLV dP/dtmax) and on LV ejection fraction (LVEF) at baseline: group I (n = 18): ΔLV dP/dtmax >100{\%} and LVEF >25{\%}; group IIa (n = 17): ΔLV dP/dtmax ≤100{\%} and LVEF > 25{\%}; and group IIb (n = 11): ΔLV dP/dtmax ≤100{\%} and LVEF ≤25{\%}. The amounts of beta1-adrenergic receptor, sarcoplasmic reticulum Ca2+-adenosine triphosphatase, and phospholamban mRNA were significantly smaller in groups IIa and IIb than in group I. The plasma norepinephrine level was increased and the delayed heart/mediastinum count ratio in MIBG scintigraphy was decreased in both groups IIa and IIb. Conclusions: Dobutamine stress testing is a useful diagnostic tool for identifying reduced adrenergic myocardial contractile reserve related to altered myocardial expression of beta1-adrenergic receptor, sarcoplasmic reticulum Ca2+-adenosine triphosphatase, and phospholamban genes even in asymptomatic or mildly symptomatic patients with DCM.",
author = "Masakazu Kobayashi and Hideo Izawa and Cheng, {Xian Wu} and Hiroyuki Asano and Akihiro Hirashiki and Kazumasa Unno and Satoru Ohshima and Takashi Yamada and Yosuke Murase and Kato, {Tomoko S.} and Koji Obata and Akiko Noda and Takao Nishizawa and Satoshi Isobe and Kohzo Nagata and Tatsuaki Matsubara and Toyoaki Murohara and Mitsuhiro Yokota",
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Kobayashi, M, Izawa, H, Cheng, XW, Asano, H, Hirashiki, A, Unno, K, Ohshima, S, Yamada, T, Murase, Y, Kato, TS, Obata, K, Noda, A, Nishizawa, T, Isobe, S, Nagata, K, Matsubara, T, Murohara, T & Yokota, M 2008, 'Dobutamine Stress Testing as a Diagnostic Tool for Evaluation of Myocardial Contractile Reserve in Asymptomatic or Mildly Symptomatic Patients With Dilated Cardiomyopathy', JACC: Cardiovascular Imaging, vol. 1, no. 6, pp. 718-726. https://doi.org/10.1016/j.jcmg.2008.04.012

Dobutamine Stress Testing as a Diagnostic Tool for Evaluation of Myocardial Contractile Reserve in Asymptomatic or Mildly Symptomatic Patients With Dilated Cardiomyopathy. / Kobayashi, Masakazu; Izawa, Hideo; Cheng, Xian Wu; Asano, Hiroyuki; Hirashiki, Akihiro; Unno, Kazumasa; Ohshima, Satoru; Yamada, Takashi; Murase, Yosuke; Kato, Tomoko S.; Obata, Koji; Noda, Akiko; Nishizawa, Takao; Isobe, Satoshi; Nagata, Kohzo; Matsubara, Tatsuaki; Murohara, Toyoaki; Yokota, Mitsuhiro.

In: JACC: Cardiovascular Imaging, Vol. 1, No. 6, 01.11.2008, p. 718-726.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Dobutamine Stress Testing as a Diagnostic Tool for Evaluation of Myocardial Contractile Reserve in Asymptomatic or Mildly Symptomatic Patients With Dilated Cardiomyopathy

AU - Kobayashi, Masakazu

AU - Izawa, Hideo

AU - Cheng, Xian Wu

AU - Asano, Hiroyuki

AU - Hirashiki, Akihiro

AU - Unno, Kazumasa

AU - Ohshima, Satoru

AU - Yamada, Takashi

AU - Murase, Yosuke

AU - Kato, Tomoko S.

AU - Obata, Koji

AU - Noda, Akiko

AU - Nishizawa, Takao

AU - Isobe, Satoshi

AU - Nagata, Kohzo

AU - Matsubara, Tatsuaki

AU - Murohara, Toyoaki

AU - Yokota, Mitsuhiro

PY - 2008/11/1

Y1 - 2008/11/1

N2 - Objectives: We performed dobutamine stress testing for evaluation of myocardial contractile reserve in asymptomatic or mildly symptomatic patients with dilated cardiomyopathy (DCM). Background: Catecholamine sensitivity is reduced in failing hearts as a result of myocardial abnormalities in the beta-adrenergic receptor signaling pathway. However, little is known about adrenergic myocardial contractile reserve in asymptomatic or mildly symptomatic patients with DCM. Methods: The maximal first derivative of left ventricular pressure (LV dP/dtmax) was determined during infusion of dobutamine (10 μg kg-1 min-1) in 46 asymptomatic or mildly symptomatic (New York Heart Association functional class I or II) patients with DCM. The expression of messenger ribonucleic acid (mRNA) for contractile regulatory proteins in endomyocardial biopsy specimens was quantified by reverse transcription and real-time polymerase chain reaction analysis. Plasma norepinephrine levels were measured in all patients and [123I]metaiodobenzylguanidine (MIBG) scintigraphy performed. Results: Patients were classified into 3 groups based on the percentage increase in LV dP/dtmax induced by dobutamine (ΔLV dP/dtmax) and on LV ejection fraction (LVEF) at baseline: group I (n = 18): ΔLV dP/dtmax >100% and LVEF >25%; group IIa (n = 17): ΔLV dP/dtmax ≤100% and LVEF > 25%; and group IIb (n = 11): ΔLV dP/dtmax ≤100% and LVEF ≤25%. The amounts of beta1-adrenergic receptor, sarcoplasmic reticulum Ca2+-adenosine triphosphatase, and phospholamban mRNA were significantly smaller in groups IIa and IIb than in group I. The plasma norepinephrine level was increased and the delayed heart/mediastinum count ratio in MIBG scintigraphy was decreased in both groups IIa and IIb. Conclusions: Dobutamine stress testing is a useful diagnostic tool for identifying reduced adrenergic myocardial contractile reserve related to altered myocardial expression of beta1-adrenergic receptor, sarcoplasmic reticulum Ca2+-adenosine triphosphatase, and phospholamban genes even in asymptomatic or mildly symptomatic patients with DCM.

AB - Objectives: We performed dobutamine stress testing for evaluation of myocardial contractile reserve in asymptomatic or mildly symptomatic patients with dilated cardiomyopathy (DCM). Background: Catecholamine sensitivity is reduced in failing hearts as a result of myocardial abnormalities in the beta-adrenergic receptor signaling pathway. However, little is known about adrenergic myocardial contractile reserve in asymptomatic or mildly symptomatic patients with DCM. Methods: The maximal first derivative of left ventricular pressure (LV dP/dtmax) was determined during infusion of dobutamine (10 μg kg-1 min-1) in 46 asymptomatic or mildly symptomatic (New York Heart Association functional class I or II) patients with DCM. The expression of messenger ribonucleic acid (mRNA) for contractile regulatory proteins in endomyocardial biopsy specimens was quantified by reverse transcription and real-time polymerase chain reaction analysis. Plasma norepinephrine levels were measured in all patients and [123I]metaiodobenzylguanidine (MIBG) scintigraphy performed. Results: Patients were classified into 3 groups based on the percentage increase in LV dP/dtmax induced by dobutamine (ΔLV dP/dtmax) and on LV ejection fraction (LVEF) at baseline: group I (n = 18): ΔLV dP/dtmax >100% and LVEF >25%; group IIa (n = 17): ΔLV dP/dtmax ≤100% and LVEF > 25%; and group IIb (n = 11): ΔLV dP/dtmax ≤100% and LVEF ≤25%. The amounts of beta1-adrenergic receptor, sarcoplasmic reticulum Ca2+-adenosine triphosphatase, and phospholamban mRNA were significantly smaller in groups IIa and IIb than in group I. The plasma norepinephrine level was increased and the delayed heart/mediastinum count ratio in MIBG scintigraphy was decreased in both groups IIa and IIb. Conclusions: Dobutamine stress testing is a useful diagnostic tool for identifying reduced adrenergic myocardial contractile reserve related to altered myocardial expression of beta1-adrenergic receptor, sarcoplasmic reticulum Ca2+-adenosine triphosphatase, and phospholamban genes even in asymptomatic or mildly symptomatic patients with DCM.

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