Pratali, Lorenza (6603105724)Lorenza (6603105724)PrataliOtasevic, Petar (55927970400)Petar (55927970400)OtasevicRigo, Fausto (6701803166)Fausto (6701803166)RigoGherardi, Sonia (8973825800)Sonia (8973825800)GherardiNeskovic, Aleksandar (35597744900)Aleksandar (35597744900)NeskovicPicano, Eugenio (7102408994)Eugenio (7102408994)Picano2025-06-132025-06-132005https://doi.org/10.1016/j.ejheart.2004.10.010https://www.scopus.com/inward/record.uri?eid=2-s2.0-23744492970&doi=10.1016%2fj.ejheart.2004.10.010&partnerID=40&md5=8615e3fc742a4d394a74c506da60a954https://remedy.med.bg.ac.rs/handle/123456789/11085Background: Diastolic dysfunction and lack of contractile reserve are unfavorable prognostic predictors in patients with dilated cardiomyopathy (DCM). Aims: This study aims to assess whether diastolic dysfunction and lack of dipyridamole-induced contractile reserve were additive predictors of poor outcome in patients with DCM. Methods: A total of 116 patients with DCM and ejection fraction (EF<35%) were studied by dipyridamole echo (0.84 mg/kg over 10 min). At rest, a restrictive filling pattern was defined as: E/A ratio >2 and an E-wave deceleration time of <140 ms on transmitral flow velocity profile. Results: Rest wall motion score index (WMSI) was 2.2±0.3 and decreased to 1.9±0.41 after dipyridamole (p<0.001). During follow-up (median 26.5 months), 22 cardiac deaths occurred. At multivariate analysis, dipyridamole-induced contractile reserve yielded significant incremental prognostic value (RR=0.275, p<0.006) over NYHA class (RR=1.971, p<0.03), angiotensin-converting enzyme inhibitor therapy (RR=0.173, p<0.001), and left ventricular end-diastolic diameter (RR=1.131, p<0.001). The worst prognostic combination was the presence of restrictive pattern at rest and the absence of contractile reserve (ΔWMSI<0.15). Conclusion: In patients with DCM, the ominous combination of restrictive transmitral flow pattern and lack of contractile reserve during dipyridamole stress predicts an unfavourable outcome. © 2004 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.Dipyridamole echocardiographyIdiopathic dilated cardiomyopathyPrognosisRestrictive pattern