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Hypotension during dobutamine stress transesophageal echocardiography: relationship with provoked left ventricular

Tariq S Siddiqui1, Buddhadeb Dawn, Marcus F Stoddard

  • 1Division of Cardiology, Department of Medicine, University of Louisville, Louisville, Kentucky 40292, USA.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|September 5, 2006
PubMed

Insights

Hypotension during dobutamine stress (DS) echocardiography is linked to provoked left ventricular outflow tract (OT) or midcavitary (MID) obstruction. These findings confirm a causal relationship between ventricular obstruction and hypotension during DS TEE.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Physiology

Background:

  • The underlying cause of hypotension during dobutamine stress (DS) echocardiography remains unclear.
  • The role of left ventricular outflow tract (OT) or midcavitary (MID) obstruction in provoking hypotension during stress echocardiography is debated.
  • This study investigates whether left ventricular OT obstruction, rather than MID obstruction, is responsible for hypotension during DS echocardiography.

Purpose of the Study:

  • To determine the mechanism of hypotension during dobutamine stress (DS) echocardiography.
  • To investigate the role of provoked left ventricular outflow tract (OT) or midcavitary (MID) obstruction in causing hypotension.
  • To test the hypothesis that left ventricular OT obstruction is the primary cause of hypotension during DS echocardiography.

Main Methods:

  • Multiplane DS transesophageal echocardiography (TEE) was performed on 142 adult patients without resting obstruction or ischemia.
  • TEE was utilized to precisely identify the site of obstruction, with dobutamine infused from 5 to 40 microg/kg/min and atropine administered as needed.
  • Continuous wave Doppler assessed for obstruction from appropriate views to evaluate provoked ventricular obstruction at the OT, MID, or both sites.

Main Results:

  • Ventricular obstruction was provoked at the OT in 13 patients, MID in 10, and both sites in 4; 115 patients served as controls without obstruction.
  • The OT and MID obstruction groups showed a significantly greater decrease in systolic blood pressure from rest to peak stress compared to controls.
  • A hypotensive response (systolic blood pressure decrease >= 20 mm Hg) was significantly more common in the OT (69%) and MID (60%) obstruction groups than in the control group (19%).

Conclusions:

  • Hypotension during DS TEE frequently occurs when ventricular obstruction is provoked.
  • Provoked left ventricular OT and MID obstructions were identified as significant predictors of a hypotensive response.
  • The study supports a causal link between provoked ventricular obstruction and the development of hypotension during DS TEE.
Abstract

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