title: Do patients with intraventricular gradients during dobutamine stress echocardiography have intraventricular gradients with exercise testing?
abstract: The development of intraventricular gradients during dobutamine stress echocardiography has been widely reported and this finding is commonly associated with symptoms during stress testing. In a previous study, we investigated the incidence of intraventricular gradients during dobutamine stress echocardiography in 46 patients and concluded that they occur frequently (43%). In another study we looked for the same phenomenon in 50 other consecutive patients during exercise stress echocardiography and only found a small gradient in one patient (2%). The purpose of the present study was to look for the development of intraventricular gradients during exercise echocardiography, in patients in whom this phenomenon occurred during dobutamine stress echocardiography. We studied 10 patients who developed a significant intraventricular gradient in a negative or inconclusive dobutamine stress echocardiography study. Five of the patients were male, mean age was 63 +/- 15.9 years (34-79). Three patients had previously undergone coronary angioplasty. The presence of intraventricular gradients was evaluated in all patients by color, pulsed and continuous wave Doppler echocardiography during dobutamine and exercise stress testing. An intraventricular gradient was considered significant when the intraventricular flow velocity increased by more than 1 m/s at the end of systole. The mean intraventricular gradient developed during dobutamine stress echocardiography was 101.7 +/- 68 mmHg (47-270). Only one of these patients developed a small intraventricular gradient during exercise stress echocardiography.
  
  
  CONCLUSIONS
  In a small population of patients who developed significant intraventricular gradients during dobutamine stress echocardiography, this finding was not reproduced with exercise echocardiography.
authors.affiliation: Serviço de Cardiologia do Hospital Garcia de Orta, Almada.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cotrim
authors.forename: Paulo
authors.initials: P
authors.lastname: Osório
authors.forename: Isabel
authors.initials: I
authors.lastname: João
authors.forename: Ana Rita
authors.initials: AR
authors.lastname: Victor
authors.forename: Pedro
authors.initials: P
authors.lastname: Cordeiro
authors.forename: Paula
authors.initials: P
authors.lastname: Fazendas
authors.forename: Luís Moura
authors.initials: LM
authors.lastname: de Oliveira
authors.forename: Manuel
authors.initials: M
authors.lastname: Carrageta
mesh_terms: D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents; D004280:Dobutamine; D025401:Echocardiography, Stress; D005080:Exercise Test; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine