Normal coronary angiogram and dobutamine-induced left ventricular obstruction during stress echocardiography: a higher hemodynamic responsiveness to dobutamine.
This study assessed the clinical or echographic factors predisposing to dynamic left ventricular obstruction (LVO) during dobutamine echocardiography (DE) in patients with angina-like chest pain but without coronary artery disease (CAD). DE is an effective technique for the noninvasive diagnosis of underlying CAD. During DE, an LVO is not unusual in ischemic patients.


METHODS
DE (5-40 microg/kg/min) was performed in 52 consecutive patients with angina-like chest pain and normal coronary angiogram. Mean (standard deviation) age was 61 +/- 10 years (27 men, 25 women). Dobutamine-induced LVO was defined as a new intracavitary flow acceleration of at least 3 msec in the left ventricle.


RESULTS
Dynamic LVO was observed during DE in 20 (38%) of the 52 patients and was not related to clinical or baseline echocardiographic parameters. The chronotropic response and the systolic blood pressure during DE were higher in the group with LVO (P < 0.03 and P < 0.05, respectively). Appearance of chest pain during the test was also more frequent when LVO occurred (P < 0.02).


CONCLUSIONS
Dynamic LVO is common during DE in a population of patients with angina-like chest pain without epicardial CAD and is associated with a higher hemodynamic responsiveness to dobutamine.
Christiaens
L
L
Département de Cardiologie, Centre Hospitalo-Universitaire de Poitiers, 350 Avenue Jacques Coeur, BP 577, 86021 Poitiers Cedex, France. l.christiaens@chu-poitiers.fr
Duplantier
C
C
Allal
J
J
Donal
E
E
Nanadoumgar
H
H
Barraine
R
R
Coisne
D
D
D000318:Adrenergic beta-Agonists / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000000981:diagnostic imaging; D017023:Coronary Angiography; D004280:Dobutamine / Q000009:adverse effects*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014694:Ventricular Outflow Obstruction / Q000139:chemically induced* / Q000000981:diagnostic imaging*
D000318:Adrenergic beta-Agonists; D004280:Dobutamine