Exercise testing for long-term follow-up in arrhythmogenic right ventricular cardiomyopathy.

OBJECTIVES: We investigated arrhythmia, electrocardiography and physical work capacity (PWC) in the follow-up of ARVC. DESIGN: Twenty-three patients (13 men; age 41±12years) fulfilling diagnostic criteria were re-investigated after at least five years. RESULTS: Ventricular arrhythmia during exercise testing (ET) was present in 14 patients (61%) and showed variation between examinations. In eleven (48%), complex ventricular ectopic activity was observed at peak exercise or immediately thereafter. Mutations known to be pathogenic in ARVC were present in 13 patients (57%) of which 11 developed complex ventricular arrhythmia at ET. PWC at baseline was 190±66W (104±26%) decreasing to 151±61W (91±23%, p=0.008) after 10.7years. CONCLUSION: The appearance of ventricular arrhythmia during exercise testing showed temporal variation but was frequent in patients with relevant genetic mutation. Physical exercise capacity decreased over time in patients with ARVC in excess to the age-related deterioration and regardless of medication.

Usefulness of rest and low-dose dobutamine wall motion scores in predicting survival and benefit from revascularization in patients with ischemic cardiomyopathy.

This study examined the value of wall motion scores at rest and with low- and high-dose dobutamine infusion for prediction of outcome and benefit from revascularization in patients with ischemic cardiomyopathy. Follow-up was obtained in 139 patients with ischemic cardiomyopathy who had echocardiography at rest, and during low- (10 microg/kg/min) and high-dose dobutamine (maximal dose 50 microg/kg/min) infusion. Both rest and low-dose wall motion scores were multivariate predictors of cardiac death, but ischemia and peak dose scores were not predictors. Rest scores risk stratified patients into 3 groups: score (1.00 to 1.99) with 11% cardiac death; score (2.00 to 2.49) with 30% death; and score > or =2.50 with 47% death. One third of patients with rest scores > or =2.50 had improvement in scores to < 2.50 with low-dose dobutamine. Their frequency of cardiac death was reduced to 23% compared with 60% (p = 0.04) in those who remained with low-dose scores > or =2.50. Low-dose scores also identified those who benefited from revascularization. In patients with low-dose scores (1.00 to 1.99), the frequency of cardiac death was marginally lower in revascularized than nonrevascularized patients (10% vs 21%, p = 0.28). In patients with scores (2.00 to 2.49), revascularized patients had a significantly lower frequency of cardiac death than nonrevascularized patients (15% vs 41%, p < 0.05). The frequency of death in those with low-dose scores > or =2.50 was very high in both revascularized (75%) and nonrevascularized (56%, p = 0.42) patients. Thus, rest and low-dose wall motion scores enable risk stratification of patients with ischemic cardiomyopathy and identify those who do and do not benefit from revascularization.