Prevalence and significance of left ventricular outflow gradient during dobutamine echocardiography
D Luria1, M W Klutstein, D Rosenmann
1Department of Cardiology, Jesselson Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel.
Insights
Dynamic left ventricle outflow gradient during dobutamine stress echocardiography is occasionally observed but lacks clinical significance. This finding suggests it does not impact patient outcomes or indicate underlying physiological issues.
Area of Science:
- Cardiology
- Echocardiography
- Physiology
Background:
- A dynamic left ventricle outflow gradient can be observed during dobutamine stress echocardiography.
- The clinical and physiological significance of this gradient is not well understood.
Purpose of the Study:
- To investigate the clinical and physiological significance of dynamic left ventricle outflow gradient during dobutamine stress echocardiography.
- To determine the prevalence and clinical correlates of this phenomenon.
Main Methods:
- 394 patients underwent dobutamine stress echocardiography with Doppler.
- Prevalence of left ventricle outflow gradient was assessed and correlated with clinical and echocardiographic findings.
- 15 patients with gradient underwent exercise echocardiography.
Main Results:
- 17.5% of patients developed a left ventricle outflow gradient (>36 mmHg).
- Systolic anterior motion of the mitral valve or dynamic obstruction at papillary muscles was observed.
- No correlation found with chest pain or shortness of breath; lower frequency of ischemic wall motion abnormalities.
Conclusions:
- Left ventricle outflow gradient is an occasional finding during dobutamine stress echocardiography.
- Its presence appears to have no significant physiological or clinical impact.
Aims:
This study investigated the clinical and physiological significance of the dynamic left ventricle outflow gradient observed in some patients during dobutamine stress echocardiography.
Methods:
Three hundred and ninety-four consecutive patients completed dobutamine stress echocardiography using Doppler echocardiography to assess the presence of myocardial ischaemia and left ventricular outflow gradient. The prevalence of left ventricular outflow gradient was evaluated and correlated with echocardiographic and clinical findings. Fifteen patients with left ventricular outflow gradient during dobutamine infusion underwent exercise echocardiography for appearance of left ventricular outflow gradient.
Results:
Sixty-nine of 394 (17.5%) patients developed a left ventricular outflow gradient of more than 36 mmHg. In nine of them (13%) the anterior mitral valve leaflet had a systolic anterior motion. In 60 of the 69 patients (87%) there was a dynamic obstruction at the level of the papillary muscles. The mean intracavitary gradient was 75.4 (range 36-175) mmHg. There was no correlation between the presence or absence of a dobutamine stress echocardiography-induced left ventricle outflow gradient and chest pain or shortness of breath. In patients who developed a left ventricular outflow gradient ischaemic wall motion abnormalities occurred at a significantly lower frequency during dobutamine stress echocardiography (2.9 vs 16.4% P<0.001). None of the 15 patients who underwent exercise echocardiography developed significant left ventricular outflow gradient.
Conclusion:
Left ventricular outflow gradient occurs occasionally during dobutamine stress echocardiography examination. Its presence is of no physiological or clinical significance.
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