RESUMEN
Beta blockers improve left ventricular (LV) ejection fraction but patient responses are heterogenous. We investigated the role of contractile reserve (CR) in predicting beta-blocker response in ischemic and nonischemic cardiomyopathy. Resting and low-dose dobutamine echocardiograms were recorded in 32 patients with heart failure (LV ejection fraction Asunto(s)
Antagonistas Adrenérgicos beta/uso terapéutico
, Cardiomiopatía Dilatada/fisiopatología
, Contracción Miocárdica/fisiología
, Isquemia Miocárdica/fisiopatología
, Disfunción Ventricular Izquierda/tratamiento farmacológico
, Disfunción Ventricular Izquierda/fisiopatología
, Adulto
, Anciano
, Anciano de 80 o más Años
, Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico
, Cardiomiopatía Dilatada/complicaciones
, Cardiomiopatía Dilatada/tratamiento farmacológico
, Femenino
, Estudios de Seguimiento
, Humanos
, Masculino
, Persona de Mediana Edad
, Isquemia Miocárdica/complicaciones
, Isquemia Miocárdica/tratamiento farmacológico
, Valor Predictivo de las Pruebas
, Estudios Prospectivos
, Factores de Tiempo
, Disfunción Ventricular Izquierda/complicaciones
RESUMEN
BACKGROUND: Digital acquisition is a technique for storing echocardiographic data that offers advantages over conventional videotape (VT); however, limited information is available on its accuracy for the evaluation of valvular regurgitation. METHODS: We evaluated 102 patients with at least 1 regurgitant lesion. Data were obtained on VT and in 1 cardiac cycle stored digitally (1C). To assess for incremental improvement with acquisition of multiple cycles, digital images were also acquired with 2 (2C) or 3 cardiac cycles (3C). Both digital and VT images were graded for regurgitant severity as absent, trivial, mild, moderate, or severe. Kappa statistics were used to assess agreement. RESULTS: A total of 171 valvular regurgitant lesions (mild or greater) were evaluated. The overall agreement between 1C and VT images was kappa = 0.61. With multiple cycle acquisition, there was no improvement in agreement (kappa = 0.56 and 0.57 for 2C and 3C, respectively). When subgrouped, the level of agreement between 1C and VT was slightly lower for the aortic valve than for the mitral or tricuspid valves (kappa = 0.49, 0.63, 0.64, respectively). CONCLUSION: The 1C technique has substantial agreement and correlation with standard VT for the evaluation of regurgitant lesions with the use of color flow Doppler. The acquisition of multiple cardiac cycles does not provide incremental improvement over single beat acquisition.