Prevalence and Prognostic Value of Ejection Fraction Increase Obtained with Amrinone in Patients with Ischemic Cardiomiopathy

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Abstract

Background and objectives In isquemic dilated cardiomyopathy, with severe depression of ventricular function, the ejection fraction in-crease with amrinone, identifies those patients which obtain an ejection fraction increase after myocardial revascularization and has better survival in the follow-up. Is the aim of this study: 1) to evaluate the prevalence of positive responses to amrinone in the population without myocardial revascularization; 2) the prognostic value of amrinone ejection fraction in this population. Method So we analyzed from our first protocol in a retrospective way 111 patients with severe depression of ventricularfunction followed during sixty months with medical treatment from the radionuclid angiography we assessed the resting ejection and ejection fraction at 20 minutes after amrinone intravenous administration (1 mg/kg). Following the original protocol positive response was defined as an increment of at least 30% from the resting ejection fraction and a negative response as a failure to get it. Results Group negative amrinone ejection (n = 82 patients), with living (n = 45 patients), age 59 ± 13 years, resting ejection fraction 26 ± 18%, amrinone ejection fraction27 ± 20%, and deaths (n = 37 patients), with age 57 ± 18years, resting ejection fraction 21 ± 14% (p: NS), amrinone ejection fraction 22±14% (p: NS). Survival 56%. Group positive ejection fraction (n = 29 patients), with living (n = 20 patients), with age 55 ± 3 years, resting ejection fraction 27±23%, amrinone ejection fraction40 ± 13 %,and deaths 9 patients with 61±18 years, resting ejection fraction 20 ± 15 % (p: NS), amrinone ejection fraction 32 ±18% (p <0.01). Survival 69%. Conclusions Twenty-six per cent of patients with severe depression of ventricular function show positive response to amrinone. The resting ejection fraction does not identify those patients with better survival. This population presented high mortality, nevertheless those with positive response show better survival and absolute value of the resting ejection fraction significantly higher.The present data suggest that this group would have higher myocardial viability reserve which could be recovered by means of myocardial revascularization.