Document Detail


Left ventricular diastolic filling pressures during dobutamine stress echocardiography: relationship to symptoms and ischemia.
MedLine Citation:
PMID:  19524401     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Limited information exists regarding the relationship of left ventricular diastolic filling parameters measured by Doppler echocardiography during dobutamine stress echocardiography (DSE) and stress-induced symptoms or myocardial ischemia. METHODS: To determine if there is an association between Doppler parameters of left ventricular filling and symptoms and ischemic wall motion abnormalities during DSE, the authors prospectively studied 219 patients (mean age, 66+/-11 years; 55% men) referred for clinically indicated DSE. Pulsed-wave Doppler measurements of mitral inflow and medial annular tissue velocities at baseline, 20 microg/kg/min, peak stress, and recovery were made. Patients were classified as having stress-induced ischemia (n=70) or no ischemia (n=149) on the basis of the development of new or worsening wall motion abnormalities. RESULTS: Patients who developed ischemia had lower baseline and peak stress diastolic annular tissue velocities (e') (5.7+/-1.9 vs 6.4+/-1.9 cm/s at baseline, P=0.02; 5.2+/-1.6 vs 7.4+/-2.4 cm/s at peak stress, P<.0001). At peak stress, the E/e' ratio was higher (13.1+/-6.3 vs 10.2+/-4.2, P=.003); these differences persisted into recovery. The increase in E/e' from 20 microg/kg/min to peak stress was greater (0.9+/ 2.1 vs -0.8+/-3.1, P=.0009) in patients who developed symptoms during DSE and in patients who presented with dyspnea (0.3+/-2.6 vs -1.0+/-3.2, P=.02). The change in e' velocity from baseline to peak stress, the change in E/e' from baseline to recovery, known coronary artery disease, and the development of symptoms during DSE were independently associated with ischemia. CONCLUSIONS: The development of symptoms and myocardial ischemia during DSE are both associated with an increase in E/e'. The prognostic implications of elevated E/e' during DSE have yet to be elucidated.
Authors:
Yoshie Nakajima; Garvan C Kane; Robert B McCully; Steve R Ommen; Patricia A Pellikka
Publication Detail:
Type:  Controlled Clinical Trial; Journal Article     Date:  2009-06-12
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  22     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-08-03     Completed Date:  2009-10-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  947-53     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Diseases and the Mayo Clinic, Rochester, MN 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Blood Pressure / drug effects*
Cardiotonic Agents / diagnostic use
Dobutamine / diagnostic use*
Echocardiography / methods*
Exercise Test
Female
Humans
Male
Myocardial Ischemia / complications*,  ultrasonography*
Reproducibility of Results
Sensitivity and Specificity
Ventricular Dysfunction, Left / etiology*,  ultrasonography*
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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