Chest
Volume 122, Issue 2, August 2002, Pages 542-548
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Clinical Investigations
CARDIOLOGY
Dobutamine Gated Blood Pool Scintigraphy Predicts the Improvement of Cardiac Sympathetic Nerve Activity, Cardiac Function, and Symptoms After Treatment in Patients With Dilated Cardiomyopathy

https://doi.org/10.1378/chest.122.2.542Get rights and content

Background

We evaluated whether dobutamine gated blood pool scintigraphy (DOB-GBP) can predict improvement in cardiac sympathetic nerve activity and cardiac function after β-blocker therapy in patients with dilated cardiomyopathy (DCM).

Methods and results

Twenty-two patients with DCM underwent DOB-GBP to measure left ventricular ejection fraction (LVEF) at rest, and during 5, 10, and 15 μg/kg/min of dobutamine infusion before therapy. Examinations were performed before and after 1 year of therapy. The heart/mediastinum count (H/M) ratio and total defect score (TDS) were determined for 123I-meta-iodobenzylguanidine images from anterior planar image and single-photon emission CT images. LVEF and left ventricular end-diastolic dimension (LVDd) were determined by echocardiography. After 1 year of treatment, the echocardiographic LVEF improved > 5% in 11 patients (group A), but did not improve in the remaining 11 patients (group B). Before treatment, TDS, H/M, LVEF, and LVDd were similar in both groups. However, there was a greater increase in the LVEF during dobutamine infusion in group A than in group B (21 ± 8% vs 9 ± 3%, p < 0.001). If a critical value of 15% for the ΔLVEF was used to predict the improvement in LVEF after treatment, the sensitivity was 91% and specificity was 82%. The TDS, H/M ratio, LVDd, and New York Heart Association functional class improved in group A to a greater extent than in group B.

Conclusions

DOB-GBP can be used to predict improved cardiac sympathetic nerve activity, cardiac function, and symptoms after treatment in patients with DCM.

Section snippets

Study Population

Twenty-two patients, 12 men and 10 women (mean ± SD age, 56 ± 12 years; range, 35 to 78 years), with DCM were included in the study. A detailed history and physical were obtained from all of the patients. Chest radiography, standard ECG, echocardiography, 201Tl and 123I-MIBG scintigraphy, and cardiac catheterization, including coronary angiography and left ventriculography, were performed in all of the patients. Patients with acute or chronic myocarditis, significant coronary artery stenosis,

Results

There were no significant differences in the hemodynamic characteristics of the two groups. Before treatment, TDS, H/M ratio, LVEF, and LVDd were similar in both groups. ΔLVEF is shown in Figure 5. ΔLVEF in group A was 21 ± 8%, which was significantly higher than the ΔLVEF in group B (9 ± 3%, p < 0.001). The correlation was recognized between LVEF measured by echocardiography and LVEF measured by scintigraphy at rest (Fig 6). Using a critical value of 15% for the ΔLVEF to predict an improvement

Discussion

Idiopathic DCM, which is characterized by dilated ventricles and decreased systolic function, is generally regarded as having a poor prognosis. In early reports,2223 the survival rate for patients with DCM was 70 to 75% at 1 year and 50% at 5 years. However, in later reports,2425 the prognosis has improved, with a 5-year survival rate of 60 to 80%. Earlier detection of the disease, as well as the introduction of treatments with β-blockers, may be related to this improvement in prognosis.2345678

Conclusion

DOB-GBP can be used to predict improvement in cardiac sympathetic nerve activity, cardiac function, and symptoms after treatment with β-blocker in patients with DCM.

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