title: Impaired left ventricular stroke volume reserve during clinical dobutamine stress predicts future episodes of pulmonary edema.
abstract: OBJECTIVE
  The purpose of this study was to determine whether dobutamine-induced abnormal stress changes in left ventricular stroke volume (LVSV) and aortic stiffness predict future pulmonary edema.
  
  
  BACKGROUND
  Increased aortic stiffness that decreases LVSV during adrenergic stress may serve as a marker for future pulmonary edema (PE).
  
  
  METHODS
  We measured LVSV, ventriculovascular stiffness (pulse pressure/LVSV(index)), and aortic distensibility at rest and during intravenous dobutamine administration using cardiovascular magnetic resonance. Personnel blinded to dobutamine cardiovascular magnetic resonance followed participants longitudinally over time to identify those admitted to the hospital with PE. Data for 44 participants who had a hospital admission for PE were compared with data for 72 participants of similar age, sex, and resting left ventricular ejection fraction who remained PE free.
  
  
  RESULTS
  Expressed as median and interquartile range, participants with and without PE exhibited a decreased stress/rest LVSV ratio (0.9 [range 0.7 to 1.1] vs. 1.0 [range 0.9 to 1.2], respectively; p = 0.002), an increased ventriculovascular stiffness stress/rest ratio (1.4 [range 1.0 to 1.6] vs. 1.0 [range 0.8 to 1.3], respectively; p ≤ 0.001); and a decreased stress-induced measure of aortic distensibility (0.8 mm Hg(-3) [range 0.3 to 1.3 mm Hg(-3)] vs. 1.6 mm Hg(-3) [range 1.2 to 3.2 mm Hg(-3)], respectively; p = 0.002). After accounting for age, sex, left ventricular ejection fraction, risk factors for PE, and the presence of dobutamine-induced ischemia, LVSV reserve and the stress/rest ventriculovascular stiffness ratio still differed (p < 0.008 for both) in those with and without PE.
  
  
  CONCLUSIONS
  In patients without inducible ischemia during dobutamine stress testing in whom one might otherwise assume a favorable prognosis, the failure to increase LVSV or an increase in ventriculovascular stiffness indicates patients at risk of subsequent PE.
authors.affiliation: Department of Internal Medicine (Cardiology Section), Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.
authors.forename: Charaslak
authors.initials: C
authors.lastname: Charoenpanichkit
authors.forename: William C
authors.initials: WC
authors.lastname: Little
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Mandapaka
authors.forename: Erica
authors.initials: E
authors.lastname: Dall'Armellina
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Morgan
authors.forename: Craig A
authors.initials: CA
authors.lastname: Hamilton
authors.forename: W Gregory
authors.initials: WG
authors.lastname: Hundley
mesh_terms: D000368:Aged; D001285:Atropine; D004280:Dobutamine; D005260:Female; D006333:Heart Failure; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000175:diagnosis*; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology*
chemical_list: D004280:Dobutamine; D001285:Atropine