[Safety of stress echocardiography with dobutamine used in patients with aortic stenosis and left ventricular dysfunction].
OBJECTIVE
The aim of the study was to assess the safety of dobutamine echocardiography (DE) in patients with aortic stenosis and left ventricular ejection fraction < or = 45%.


METHODS
162 patients (mean age 59 +/- 13, 64% males) with resting transvalvular peak gradient < 70 mmHg underwent standard DE (doses 5-40 micrograms/kg/min) in a multicenter study involving 10 centers from Poland and Hungary. This analysis involves a subset of 39 pts (34 M, 5 F, age 59 +/- 13) identified according to the criterion of EF < or = 45% and mean aortic gradient < or = 35 mmHg. Clinically indicated coronary arteriography was performed in all patients with left ventricular dysfunction.


RESULTS
Peak dobutamine dose was 29 +/- 10 micrograms/kg/min. Peak heart rate was 112 +/- 26 bpm. Systolic arterial pressure was 148 +/- 20 mmHg and diastolic pressure 86 +/- 14 mmHg. Transaortic mean gradient and aortic valve area increased 35 +/- 34% and 19 +/- 15% during peak dobutamine dose, respectively. Ejection fraction improved 16 +/- 14%. The test was positive in 17 (43.6%) patients, negative in 11 (28.2%) patients and non diagnostic in 11 (28.2%) patients. There were no deaths, myocardial infarctions or episodes of sustained ventricular tachycardia as a result of DE. The test was terminated when the following conditions were met: Target heart rate (23.%). Left ventricular asynergy (46.2%). Maximal established dose achieved (7.7%). Side effects (20.5%). The most common side effects were ventricular arrhythmias (35.9%), dyspnea (20.5%) and hypotension < 20 mmHg (10.3%).


CONCLUSIONS
Despite frequent side effects, DE can be safely performed in patients with aortic stenosis and depressed left ventricular contractility.
Płońska
Edyta
E
Klinika Kardiologii PAM w Szczecinie. edytaplonska@life.pl
Gasior
Zbigniew
Z
Szyszka
Andrzej
A
Kasprzak
Jarosław
J
Gackowski
Andrzej
A
Maciejewski
Marek
M
Krzymińska-Stasiuk
Elzbieta
E
Kowalik
Ilona
I
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging*; D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D001794:Blood Pressure / Q000187:drug effects; D004280:Dobutamine / Q000008:administration & dosage / Q000009:adverse effects*; D004417:Dyspnea / Q000139:chemically induced*; D025401:Echocardiography, Stress; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007022:Hypotension / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000187:drug effects
D004280:Dobutamine