Left ventricular diastolic filling pressures during dobutamine stress echocardiography: relationship to symptoms and ischemia.
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.
Nakajima
Yoshie
Y
Division of Cardiovascular Diseases and the Mayo Clinic, Rochester, MN 55905, USA.
Kane
Garvan C
GC
McCully
Robert B
RB
Ommen
Steve R
SR
Pellikka
Patricia A
PA
D000368:Aged; D001794:Blood Pressure / Q000187:drug effects*; D002316:Cardiotonic Agents; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications* / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*
D002316:Cardiotonic Agents; D004280:Dobutamine