title: Haemodynamic response during low-dose dobutamine infusion in patients with chronic systolic heart failure: comparison of echocardiographic and invasive measurements.
abstract: OBJECTIVE
  To investigate whether left ventricular (LV) systolic shortening velocity (s'), diastolic lengthening velocity (e'), and non-invasively estimated LV filling pressure (E/e') during low-dose dobutamine echocardiography (LDDE) reflect invasive measures of cardiac output and pulmonary capillary wedge pressure (PCWP) in stable patients with chronic systolic heart failure.
  
  
  RESULTS
  Fourteen patients with heart failure (aged 65 ± 8 years, LVEF 36 ± 8%) underwent simultaneous tissue Doppler echocardiography and invasive measurements of cardiac output and PCWP by right heart catheterization at rest and during dobutamine infusion at rates of 10 and 20 µg/kg/min. Cardiac output increased from rest to peak dobutamine (4.9 ± 1.2 to 6.6 ± 2.0 L/min, P < 0.001) and correlated with the peak systolic tissue velocity (s') at rest (R = 0.61, P = 0.02) and during dobutamine stimulation (R = 0.79, P < 0.001). Increases in early diastolic mitral inflow (E, 74.9 ± 29.0-90.8 ± 29.5 cm/s) and LV lengthening (e', 6.5 ± 2.4-8.2 ± 2.8 cm/s) velocities were observed during LDDE leaving the E/e' ratio unchanged. Although a mean PCWP was also unchanged from rest to peak dobutamine (16.6 ± 8.3-14.2 ± 9.2, P = 0.25), E/e' and PCWP only correlated at rest (R = 0.64, P = 0.014).
  
  
  CONCLUSIONS
  The LV systolic shortening velocity is closely associated with cardiac output during LDDE in CHF patients. Dobutamine stimulation increases early diastolic mitral inflow and lengthening velocities, but the E/e' ratio does not reflect the PCWP during LDDE, which warrants some caution in converting changes in E/e' into changes in LV filling pressure. The sample size is, however, small and the observation need to be confirmed in a larger population.
authors.affiliation: Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Nordre Fasanvej 59, Frederiksberg, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Egstrup
authors.forename: Ida
authors.initials: I
authors.lastname: Gustafsson
authors.forename: Mads Jønsson
authors.initials: MJ
authors.lastname: Andersen
authors.forename: Caroline Nervil
authors.initials: CN
authors.lastname: Kistorp
authors.forename: Morten
authors.initials: M
authors.lastname: Schou
authors.forename: Christian Ditlev
authors.initials: CD
authors.lastname: Tuxen
authors.forename: Jacob Eifer
authors.initials: JE
authors.lastname: Møller
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods; D002302:Cardiac Output / Q000187:drug effects; D002908:Chronic Disease; D015331:Cohort Studies; D004280:Dobutamine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D054143:Heart Failure, Systolic / Q000175:diagnosis*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000187:drug effects; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D004280:Dobutamine
keywords: Chronic systolic heart failure; Filling pressure; Low-dose dobutamine echocardiography; Right heart catheterization; Tissue Doppler imaging