[Safety of stress echocardiography with dobutamine used in patients with aortic stenosis and left ventricular...

Area of Science:

• Cardiology
• Diagnostic Imaging

Background:

• Aortic stenosis (AS) is a common valvular heart disease, often associated with left ventricular dysfunction.
• Assessing cardiac function in AS patients with reduced ejection fraction (EF) is crucial for management.
• Dobutamine echocardiography (DE) is a stress test used to evaluate myocardial viability and contractility.

Purpose of the Study:

• To evaluate the safety and feasibility of dobutamine echocardiography (DE) in patients diagnosed with aortic stenosis (AS) and a left ventricular ejection fraction (LVEF) of 45% or less.
• To identify potential risks and adverse events associated with DE in this specific patient population.

Main Methods:

• A multicenter study involving 10 centers in Poland and Hungary included 162 patients with AS.
• A subset of 39 patients with LVEF ≤ 45% and a mean aortic gradient ≤ 35 mmHg underwent standard DE.
• Coronary arteriography was performed in all patients with left ventricular dysfunction.

Main Results:

• The mean peak dobutamine dose administered was 29 ± 10 µg/kg/min, with a peak heart rate of 112 ± 26 bpm.
• DE demonstrated improvements in ejection fraction by 16 ± 14%, transaortic mean gradient by 35 ± 34%, and aortic valve area by 19 ± 15%.
• No deaths or myocardial infarctions occurred; however, side effects such as ventricular arrhythmias (35.9%), dyspnea (20.5%), and hypotension (10.3%) were observed.

Conclusions:

• Dobutamine echocardiography (DE) can be safely conducted in patients with aortic stenosis and impaired left ventricular contractility.
• Despite a notable incidence of side effects, DE provides valuable diagnostic information in this high-risk group.
• The study supports the use of DE as a safe and informative tool for assessing cardiac function in AS patients with reduced LVEF.