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

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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/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/inward/citedby.url?scp=56049092001&partnerID=8YFLogxK

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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