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Aims: To determine prognostic significance of global left ventricular (LV) contractile reserve, defined by dobutamine-induced changes of Tei index (Delta Tei), in patients with dilated cardiomyopathy (DCM)., Methods and Results: Thirty-eight patients with idiopathic DCM underwent high-dose (up to 40 microg/kg/min) dobutamine stress echocardiography. Prognostic value of different indices of LV contractile reserve, including Delta Tei, as well as changes of ejection fraction (Delta EF) and wall motion score index (Delta WMSi), was analysed. Patients were followed up for 5 years for cardiac mortality. Patients with preserved contractile reserve, defined by Delta Tei > -0.35, had significantly lower cardiac mortality when compared with those without it (38 vs. 77%, P = 0.02). Also, the Kaplan-Meier survival analysis revealed that patients with contractile reserve had better 5-year survival when compared with those without contractile reserve (log-rank = 6.01, P = 0.014). However, of all examined indices of contractile reserve, Cox's regression analysis identified Delta WMSi as the only independent predictor of 5-year mortality., Conclusion: Our data indicate that the presence of contractile reserve assessed by Delta Tei may identify patients with favourable long-term prognosis. Prognostic value of Delta Tei appears to be similar to Delta EF, but less powerful than Delta WMSi.

Background: Gestational hypertension (GH) is associated with hemodynamic changes, and alterations of systolic and diastolic left ventricular (LV) function. However, the magnitude and pattern of changes of different parameters of LV function and contractility in this patient population have not been fully clarified., Methods: Thirty-five pregnant women with GH underwent three echocardiographic examinations, in second and third trimester of pregnancy, and 1 month after delivery. Twelve normotensive pregnant women served as gestational age-matched controls. Hemodynamic parameters and standard indexes of LV systolic and diastolic function were analyzed. Additionally, we have measured peak systolic velocity of mitral annulus (S'), end-systolic elastance (Ees), and early transmitral to early lengthening velocity of mitral annulus ratio (E/E') as parameters of longitudinal function, contractility, and filling, respectively., Results: Women with GH had initially higher body weight, blood pressure, and heart rate (P < 0.005, P < 0.0001, and P = 0.011, respectively). Temporal analysis of different echocardiographic parameters revealed increase in wall thickness from baseline to second measurement, with consequential increase in LV mass in women with GH (P = 0.014 for septum, P = 0.010 for posterior wall, and P = 0.09 for LV mass). No significant changes of LV volumes, ejection fraction (EF), transmitral flow parameters, S', Ees, and E/E' were observed throughout the follow-up in both groups (P = nonsignificant for all). Importantly, pattern of changes was similar in both groups for all examined parameters (P = nonsignificant between groups, for all)., Conclusions: It appears that changes of LV longitudinal function, filling, and contractility during pregnancy are not significant and not influenced by GH.