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

International Journal of Cardiology, 05/15/2012

In patients with acutely decompensate chronic heart failure (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.

Methods

  • 46 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, authors 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 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=–0.37, p=0.02) and increased the value of the multivariate model from r2=0.46 to 0.58, p=0.02.

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