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
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).
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).
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=-0.59, b=-0.65,
b=0.41, and b=-0.44, b=-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 r(2)=0.46 to 0.58 for NYHA improvement and from r(2)=0.44 to
0.70, for the BNP reduction and from r(2)=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=-0.37, p=0.02) and increased the value of the multivariate
model from r(2)= 0.46 to 0.58, p=0.02.
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. (c) 2010 Elsevier Ireland Ltd. All rights reserved
