Skip to main content
Download PDF

Contractile reserve as a predictor of prognosis in patients with non-ischaemic systolic heart failure and dilated cardiomyopathy: a systematic review and meta-analysis

Echo Research & Practice volume 5, pages 1–9 (2018)Cite this article

Abstract

Objective: Patients with non-ischaemic systolic heart failure (HF) and idiopathic dilated cardiomyopathy (DCM) are a heterogenous group with varied morbidity and mortality. Prognostication in this group is challenging. We performed a systematic review and meta-analysis to examine the significance of the presence of contractile reserve as assessed via stress imaging on mortality and hospitalisation.

Methods: A search for studies that non-invasively assessed contractile reserve in patients with DCM or non-ischaemic HF with reduced ejection fraction, stress imaging with follow-up data comparing outcomes. A range of imaging modalities and stressors were included. We examined primary endpoints of mortality and secondary endpoints of combined cardiovascular events including HF progression or hospitalisation. Our analysis compared endpoints in patients with contractile reserve and those without it.

Results: Nine prospective cohort studies were identified describing a total of 787 patients. These studies are methodologically but not statistically heterogenous (I2 = 31%). Using a random effect model, the presence of contractile reserve was associated with a significantly lower risk of mortality and cardiovascular events odds ratios of 0.20 (CI 0.11, 0.39) (P < 0.00001) and 0.13 (CI 0.04, 0.40) (P = 0.0004), respectively.

Conclusion: Regardless of stressor and imaging modality and despite the significant methodological heterogeneity within the current data (imaging techniques and parameters), patients with non-ischaemic cardiomyopathy and reduced EF who demonstrate contractile reserve have a lower mortality, and lower events/hospitalisations. The presence of contractile reserve therefore offers a potential positive prognostic indicator when managing these patients.

References

  1. Meta-analysis Global Group in Chronic Heart Failure (MAGGIC). The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis. European Heart Journal 201233 1750–1757. https://doi.org/10.1093/eurheartj/ehr254)

    Article  Google Scholar 

  2. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. European Journal of Heart Failure 201618 891–975. https://doi.org/10.1002/ejhf.592)

    Article  PubMed  Google Scholar 

  3. Ouwerkerk W, Voors AA & Zwinderman AH. Factors influencing the predictive power of models for predicting mortality and/or heart failure hospitalization in patients with heart failure. JACC Heart Failure 20142 429–436. https://doi.org/10.1016/j.jchf.2014.04.006)

    Article  PubMed  Google Scholar 

  4. Sicari R, Nihoyannopoulos P, Evangelista A, Kasprzak J, Lancellotti P, Poldermans D, Voigt JU, Zamorano JL & European Association of Echocardiography. Stress echocardiography expert consensus statement: European Association of Echocardiography (EAE) (a registered branch of the ESC). European Journal of Echocardiography 20089 415–437. https://doi.org/10.1093/ejechocard/jen175)

    Article  PubMed  Google Scholar 

  5. Sugrue DD, Rodeheffer RJ, Codd MB, Ballard DJ, Fuster V & Gersh BJ. The clinical course of idiopathic dilated cardiomyopathy. A population-based study. Annals of Internal Medicine 1992117 117–123.

    Article  CAS  PubMed  Google Scholar 

  6. Ciaccheri M, Castelli G, Nannini M, Santoro G, Troiani V, Di Lenarda A, Miani D, Sinagra G, Mestroni L, Risoli A, et al. The prognostic assessment of dilated cardiomyopathy: a follow-up of 138 patients. Giornale Italiano Di Cardiologia 199020 645–650.

    CAS  PubMed  Google Scholar 

  7. Hofmann T, Meinertz T, Kasper W, Geibel A, Zehender M, Hohnloser S, Stienen U, Treese N & Just H. Mode of death in idiopathic dilated cardiomyopathy: a multivariate analysis of prognostic determinants. American Heart Journal 1988116 1455–1463. https://doi.org/10.1016/0002-8703(88)90728-4)

    Article  CAS  PubMed  Google Scholar 

  8. Parakh K1, Kittleson MM, Heidecker B, Wittstein IS, Judge DP, Champion HC, Barouch LA, Baughman KL, Russell SD, Kasper EK, et al. The variable natural history of idiopathic dilated cardiomyopathy. Israel Medical Association Journal 201214 666–671.

    Google Scholar 

  9. Marmor A & Schneeweiss A. Prognostic value of non-invasively obtained left ventricular contractile reserve in patients with severe heart failure. JACC: Journal of the American College of Cardiology 199729 422–428. https://doi.org/10.1016/S0735-1097(96)00493-7)

    Article  CAS  PubMed  Google Scholar 

  10. Pratali L, Picano E, Otasevic P, Vigna C, Palinkas A, Cortigiani L, Dodi C, Bojic D, Varga A, Csanady M, et al. Prognostic significance of the dobutamine echocardiography test in idiopathic dilated cardiomyopathy. American Journal of Cardiology 200188 1374–1378. https://doi.org/10.1016/S0002-9149(01)02116-6)

    Article  CAS  PubMed  Google Scholar 

  11. Gregg DE. Effect of coronary perfusion pressure or coronary flow on oxygen usage of the myocardium. Circulation Research 196313 497e500.

    Article  Google Scholar 

  12. Biaggioni I, Olafsson B, Robertson RM, Hollister AS & Robertson D. Cardiovascular and respiratory effects of adenosine in conscious man. Evidence for chemo- receptor activation. Circulation Research 198761 779e86.

    Article  Google Scholar 

  13. Kobayashi M1, Izawa H, Cheng XW, Asano H, Hirashiki A, Unno K, Ohshima S, Yamada T, Murase Y, Kato TS, et al. Dobutamine stress testing as a diagnostic tool for evaluation of myocardial contractile reserve in asymptomatic or mildly symptomatic patients with dilated cardiomyopathy. JACC: Cardiovascular Imaging 20081 718–726. https://doi.org/10.1016/j.jcmg.2008.04.012)

    PubMed  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG & The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Medicine 20096 e1000097. https://doi.org/10.1371/journal.pmed.1000097)

    Article  PubMed  PubMed Central  Google Scholar 

  15. Richardson P, McKenna W, Bristow M, Maisch B, Mautner B, O’Connell J, Olsen E, Thiene G, Goodwin J, Gyarfas I, et al. Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the definition and classification of cardiomyopathies. Circulation 1996 93 841–842. https://doi.org/10.1161/01.CIR.93.5.841)

    Article  CAS  PubMed  Google Scholar 

  16. Matsumoto K, Tanaka H, Kaneko A, Ryo K, Fukuda Y, Tatsumi K, Kawai H & Hirata K. Contractile reserve assessed by three-dimensional global circumferential strain as a predictor of cardiovascular events in patients with idiopathic dilated cardiomyopathy. Journal of the American Society of Echocardiography 201225 1299–1308. https://doi.org/10.1016/j.echo.2012.09.018)

    Article  PubMed  Google Scholar 

  17. Matsumoto K, Tanaka H, Onishi A, Motoji Y, Tatsumi K, Sawa T, Miyoshi T, Imanishi J, Mochizuki Y & Hirata K. Bi-ventricular contractile reserve offers an incremental prognostic value for patients with dilated cardiomyopathy. European Heart Journal: Cardiovascular Imaging 201516 1213–1223. https://doi.org/10.1093/ehjci/jev069)

    PubMed  Google Scholar 

  18. van Zalen J, Patel NR J, Podd S, Raju P, McIntosh R, Brickley G, Beale L, Sturridge LP & Lloyd GWL. Prognostic importance of tissue velocity imaging during exercise echocardiography in patients with systolic heart failure. Echo Research and Practice 20152 19–27. https://doi.org/10.1530/ERP-14-0074)

    Article  PubMed  PubMed Central  Google Scholar 

  19. Minoshima M, Noda A, Kobayashi M, Miyata S, Hirashiki A, Okumura T, Izawa H, Ishii H, Kondo T & Murohara T. Endomyocardial radial strain rate imaging during dobutamine stress echocardiography for the evaluation of contractile reserve in patients with dilated cardiomyopathy. Journal of Clinical Ultrasound 2016 44 555–560. https://doi.org/10.1002/jcu.22376)

    Article  PubMed  Google Scholar 

  20. Stipac AV, Otasevic P, Popovic ZB, Cvorovic V, Putnikovic B, Stankovic I & Nesković AN. Prognostic significance of contractile reserve assessed by dobutamine-induced changes of Tei index in patients with idiopathic dilated cardiomyopathy. European Journal of Echocardiography 201011 264–270. https://doi.org/10.1093/ejechocard/jep208)

    Article  PubMed  Google Scholar 

  21. Pratali L, Otasevic P, Neskovic A, Molinaro S & Picano E. Prognostic value of pharmacologic stress echocardiography in patients with idiopathic dilated cardiomyopathy: a prospective, head-to-head comparison between dipyridamole and dobutamine test. Journal of Cardiac Failure 200713 836–842. https://doi.org/10.1016/j.cardfail.2007.07.011)

    Article  PubMed  Google Scholar 

  22. Pinamonti B, Perkan A, Di Lenarda A, Gregori D & Sinagra G. Dobutamine echocardiography in idiopathic dilated cardiomyopathy: clinical and prognostic implications. European Journal of Heart Failure 20024 49–61. https://doi.org/10.1016/S1388-9842(01)00208-2)

    Article  PubMed  Google Scholar 

  23. Pratali L, Otasevic P, Rigo F, Gherardi S, Neskovic A & Picano E. The additive prognostic value of restrictive pattern and dipyridamole-induced contractile reserve in idiopathic dilated cardiomyopathy. European Journal of Heart Failure 20057 844–851. https://doi.org/10.1016/j.ejheart.2004.10.010)

    Article  CAS  PubMed  Google Scholar 

  24. Parthenakis F, Patrianakos A, Nyktari E, Arfanakis D, Zacharis E & Vardas P. Prognostic value of NT-pro BNP, left ventricular inotropic reserve and cardiopulmonary exercise test in patients with non-ischemic dilated cardiomyopathy. International Journal of Cardiology 2011147 326–328. https://doi.org/10.1016/j.ijcard.2010.12.079)

    Article  PubMed  Google Scholar 

  25. Ramahi TM, Longo MD, Cadariu AR, Rohlfs K, Slade M, Carolan S, Vallejo E & Wackers FJ. Dobutamine-induced augmentation of left ventricular ejection fraction predicts survival of heart failure patients with severe non-ischaemic cardiomyopathy. European Heart Journal 200122 849–856. https://doi.org/10.1053/euhj.2001.2654)

    Article  CAS  PubMed  Google Scholar 

  26. Nagaoka H, Isobe N, Kubota S, Iizuka T, Imai S, Suzuki T & Nagai R. Myocardial contractile reserve as prognostic determinant in patients with idiopathic dilated cardiomyopathy without overt heart failure. Chest 1997111 344–350. https://doi.org/10.1378/chest.111.2.344)

    Article  CAS  PubMed  Google Scholar 

  27. Rigo F, Gherardi S, Galderisi M, Sicari R & Picano E. The independent prognostic value of contractile and coronary flow reserve determined by dipyridamole stress echocardiography in patients with idiopathic dilated cardiomyopathy. American Journal of Cardiology 200799 1154–1158. https://doi.org/10.1016/j.amjcard.2006.11.049)

    Article  PubMed  Google Scholar 

Download references

Funding

This work did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Author information

Authors and Affiliations

  1. Barts Heart Centre, St Bartholomew’s Hospital, London, UK

    Peter H. Waddingham MBBS BSc MRCP, Sanjeev Bhattacharyya MB ChB MRCP MD, Jet Van Zalen MSc & Guy Lloyd MBBS MD FRCP

  2. Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex, UK

    Sanjeev Bhattacharyya MB ChB MRCP MD

Authors
  1. Peter H. Waddingham MBBS BSc MRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sanjeev Bhattacharyya MB ChB MRCP MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jet Van Zalen MSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Guy Lloyd MBBS MD FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.(http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Waddingham, P.H., Bhattacharyya, S., Van Zalen, J. et al. Contractile reserve as a predictor of prognosis in patients with non-ischaemic systolic heart failure and dilated cardiomyopathy: a systematic review and meta-analysis. Echo Res Pract 5, 1–9 (2018). https://doi.org/10.1530/ERP-17-0054

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1530/ERP-17-0054

Key Words

Echo Research & Practice

ISSN: 2055-0464

Contact us