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

doi: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

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

Internal Medicine

Research output: Contribution to journal › Article › peer-review

40 Citations (Scopus)

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/dt_max) 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/dt_max induced by dobutamine (ΔLV dP/dt_max) and on LV ejection fraction (LVEF) at baseline: group I (n = 18): ΔLV dP/dt_max >100% and LVEF >25%; group IIa (n = 17): ΔLV dP/dt_max ≤100% and LVEF > 25%; and group IIb (n = 11): ΔLV dP/dt_max ≤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 language	English
Pages (from-to)	718-726
Number of pages	9
Journal	JACC: Cardiovascular Imaging
Volume	1
Issue number	6
DOIs	https://doi.org/10.1016/j.jcmg.2008.04.012
Publication status	Published - 11-2008

All Science Journal Classification (ASJC) codes

Radiology Nuclear Medicine and imaging
Cardiology and Cardiovascular Medicine

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10.1016/j.jcmg.2008.04.012

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Kobayashi, M., Izawa, H., Cheng, X. W., Asano, H., Hirashiki, A., Unno, K., Ohshima, S., Yamada, T., Murase, Y., Kato, T. S., 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, 1(6), 718-726. https://doi.org/10.1016/j.jcmg.2008.04.012

@article{53b097cadb604c04b817f4cda6076bfc,

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

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.",

keywords = "biopsy, cardiomyopathy, contractility, dobutamine, heart failure",

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",

note = "Funding Information: This work was supported in part by a Grant-in-Aid from the Suzuken Memorial Foundation to Dr. Izawa. ",

year = "2008",

month = nov,

doi = "10.1016/j.jcmg.2008.04.012",

language = "English",

volume = "1",

pages = "718--726",

journal = "JACC: Cardiovascular Imaging",

issn = "1936-878X",

publisher = "Elsevier Inc.",

number = "6",

}

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

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

N1 - Funding Information: This work was supported in part by a Grant-in-Aid from the Suzuken Memorial Foundation to Dr. Izawa.

PY - 2008/11

Y1 - 2008/11

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.

KW - biopsy

KW - cardiomyopathy

KW - contractility

KW - dobutamine

KW - heart failure

UR - https://www.scopus.com/pages/publications/56049092001

UR - https://www.scopus.com/pages/publications/56049092001#tab=citedBy

U2 - 10.1016/j.jcmg.2008.04.012

DO - 10.1016/j.jcmg.2008.04.012

M3 - Article

C2 - 19356507

AN - SCOPUS:56049092001

SN - 1936-878X

VL - 1

SP - 718

EP - 726

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

IS - 6

ER -

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

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