Abnormal left ventricular early diastolic filling during dobutamine stress Doppler echocardiography is a sensitive indicator of significant coronary artery disease

El-Said, E. S. M.; Roelandt, Jos R.T.C.; Fioretti, P.; McNeill, Albert J.; Forster, Tamás; Boersma, H.; Linker, David T.

doi:10.1016/0735-1097(94)90165-1

Cited by 54 publications

(20 citation statements)

References 32 publications

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“…18In the present study, changes in transmitral flow velocities, commonly used to study diastolic function, were minor and non-specific during dobutamine stress and failed to distinguish control and patient groups. We were nevertheless able to identify two abnormalities that characteristically occurred during diastole.…”

Section: Discussioncontrasting

confidence: 60%

Long axis electromechanics during dobutamine stress in patients with coronary artery disease and left ventricular dysfunction

Duncan

2001

Heart

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Objective-To dissociate the eVect of inotropy from activation change during dobutamine stress on left ventricular long axis function in patients with coronary artery disease (CAD). Methods-25 patients with CAD and normal left ventricular cavity size and 30 with cavity dilatation-18 with normal activation (DCM-NA) and 12 with left bundle branch block (DCM-LBBB)-were compared with 20 controls. 12 lead ECG and septal long axis echograms were assessed at rest and peak dobutamine stress. Amplitude, shortening and lengthening velocities, postejection shortening, Q wave to onset of shortening (Q-OS), and A2 to onset of lengthening (A2-OL) were measured. Inotropy was evaluated from peak aortic acceleration. Results-In controls, amplitude, shortening and lengthening velocities, and peak aortic acceleration increased with stress; QRS, Q-OS, and A2-OL shortened (all p < 0.001); and contraction remained coordinate. In the group of patients with CAD and normal left ventricular cavity size, shortening velocity and peak aortic acceleration increased with stress (p < 0.005). However, amplitude and lengthening velocity did not change, QRS, Q-OS, and A2-OL lengthened (p < 0.01), and incoordination appeared. Results were similar in the group with DCM-NA. In the DCM-LBBB group, shortening velocity and peak aortic acceleration increased modestly with stress (p < 0.01) but amplitude, lengthening velocity, QRS, Q-OS, A2-OL, and incoordination remained unchanged. Overall, change in shortening velocity correlated with that in peak aortic acceleration (r 2 = 0.71), in amplitude with that in lengthening velocity (r 2 = 0.74), and in QRS with both Q-OS (r 2 = 0.69) and A2-OL (r 2 = 0.63). Conclusion-The normal long axis response to dobutamine reflects both inotropy and rapid activation. In CAD, inotropy is preserved with development of ischaemia but the normal increase in amplitude is lost and prolonged activation delays the time course of shortening, causing pronounced incoordination. Overall, shortening rate uniformly reflects inotropy while lengthening rate depends mainly on systolic amplitude rather than primary diastolic involvement, even with overt ischaemia. (Heart 2001;86:397-404)

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Section: Discussioncontrasting

confidence: 60%

Long axis electromechanics during dobutamine stress in patients with coronary artery disease and left ventricular dysfunction

Duncan

2001

Heart

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“…Though the importance of diastolic dysfunction has been well recognized, there are limited data in the stress echocardiography literature regarding incorporation of indexes of diastolic dysfunction during interpretation of stress echocardiography results. Recent studies have looked at global diastolic function Doppler indexes using mitral inflow pattern for prediction of ischemia during stress echocardiography with variable results (22)(23)(24). This variable result has in part been due to the load-dependent nature of these flow Doppler indexes.…”

Section: Discussionmentioning

confidence: 97%

Role of Left Atrial Size in Risk Stratification and Prognosis of Patients Undergoing Stress Echocardiography

Bangalore

Yao

Chaudhry

2007

Journal of the American College of Cardiology

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“…Myocardial ischemia impairs ventricular relaxation earlier than systolic contraction. 30 In patients with coronary artery disease, ischemia induced by pacing, 31 dipyridamole, 32 dobutamine, 33,34 and exercise 35 results in a transmitral flow pattern consistent with delayed relaxation. Even transient, reversible episodes of ischemia can impair LV relaxation and elevate LV filling pressures.…”

Section: Mechanisms Of Stress-induced Diastolic Dysfunctionmentioning

confidence: 99%

Lack of Diastolic Reserve in Patients With Heart Failure and Normal Ejection Fraction

Chattopadhyay

Alamgir

Nikitin

et al. 2010

Circ: Heart Failure

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Background-The genesis of symptoms in patients with heart failure (HF) and normal ejection fraction (HFNEF) is unclear. Most investigations of HFNEF have focused on cardiac function at rest although most of these patients are breathless only on exercise. Stress-induced impairment in systolic or diastolic function could result in these symptoms. Method and Result-Forty-one patients with HFNEF and 29 controls underwent dobutamine stress echocardiography with color tissue Doppler imaging. Wall motion score index and regional myocardial systolic velocity (Sm) were measured at and peak stress. Systolic (Sa), early diastolic (Ea), and late diastolic (Aa) mitral annular velocities were averaged over the 6 periannular sites. Mitral annular long-axis velocity was lower in the HFNEF than controls at rest. Global, regional, and long-axis systolic function did not worsen with stress in the HFNEF group. The Ea decreased and the E/Ea increased with stress in the HFNEF but not in controls. The 6-minute walk distance was shorter and negatively correlated to the E/EA ratio at rest and stress in the HFNEF group. Conclusion-Impaired diastolic reserve results in stress-induced increase in the left ventricular end-diastolic pressure in patients with HFNEF giving rise to exercise intolerance. (Circ Heart Fail. 2010;3:35-43.)

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Abnormal left ventricular early diastolic filling during dobutamine stress Doppler echocardiography is a sensitive indicator of significant coronary artery disease

Cited by 54 publications

References 32 publications

Long axis electromechanics during dobutamine stress in patients with coronary artery disease and left ventricular dysfunction

Long axis electromechanics during dobutamine stress in patients with coronary artery disease and left ventricular dysfunction

Role of Left Atrial Size in Risk Stratification and Prognosis of Patients Undergoing Stress Echocardiography

Lack of Diastolic Reserve in Patients With Heart Failure and Normal Ejection Fraction

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