Dobutamine-induced changes of left atrial two-dimensional deformation predict clinical and neurohumoral improvement after levosimendan treatment in patients with acutely decompensated chronic heart failure

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• 作者：Ioannis A. Paraskevaidis ; Ignatios Ikonomidis ; ^{ignoik@otenet.gr} ; John Parissis ; Costantinos Papadopoulos ; Vasilios Stassinos ; Vasiliki Bistola ; Maria Anastasiou-Nana
• 关键词：Left atrium ; Two (2)-dimensional strain ; Heart failure ; Speckle tracking ; Levosimendan
• 刊名：International Journal of Cardiology
• 出版年：2012
• 期刊代码：128_01675273
• 类别：med
• 出版时间：17 May, 2012
• 卷：157
• 期：1
• 页码：31-37
• 文件大小：813 K

摘要

class="h4">Background

We investigated whether dobutamine-induced changes of the left atrial (LA) two-dimensional speckle tracking parameters are related to clinical and neurohumoral improvement after levosimendan treatment in patients with acutely decompensate chronic heart failure (ADCHF).

class="h4">Methods

Forty-six patients with ADCHF and LV ejection fraction < 35%, were studied using dobutamine stress echocardiography before a 24-hour infusion of levosimendan. In a multivariable model, we included: dobutamine-induced LV contractile reserve, change (%) of LA volume, LV longitudinal strain rate and LA speckle tracking parameters to assess the improvement of NYHA class, 6-min walk distance and brain natriuretic peptide (BNP).

class="h4">Results

The change (%) of LA-contractile strain and LV longitudinal stain rate were independent determinants of improvement of NYHA class, and BNP and increase in the 6-min walk test distance (b = 鈭?#xA0;0.59, b = 鈭?#xA0;0.65, b = 0.41, and b = 鈭?#xA0;0.44, b = 鈭?#xA0;0.40, b = 0.60, respectively, p < 0.05). The addition of LA-contractile strain change in the multivariable analysis including LV longitudinal stain rate change increased the value of the model from r² = 0.46 to 0.58 for NYHA improvement and from r² = 0.44 to 0.70, for the BNP reduction and from r² = 0.49 to 0.60, for increase in the 6-min walk test distance (p < 0.05). The change (%) of LA-reservoir strain was univariate determinant for increase in the 6-min walk test distance (b = 鈭?#xA0;0.37, p = 0.02) and increased the value of the multivariate model from r² = 0.46 to 0.58, p = 0.02.

class="h4">Conclusion

In patients with ADCHF, left atrial two-dimensional speckle tracking parameters in addition to LV longitudinal strain rate may detect those patients who are prone to improve after levosimendan treatment.