Dobutamine stress echocardiography for assessing the role of dynamic intraventricular obstruction in left ventricular ballooning syndrome

Previtali, Mario; Camporotondo, Rita; Repetto, Alessandra; Panigada, Stefania

doi:10.1186/1476-7120-8-11

Cited by 7 publications

(3 citation statements)

References 24 publications

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“…Mechanism of dobutamine induced wall motion abnormality in the absence of obstructive epicardial disease is unclear. Several theories have been postulated including multivessel coronary vasospasm, severe systemic hypertension, systolic anterior motion leading to mitral regurgitation and dynamic intracavity pressure gradient secondary to left ventricular outflow tract obstruction or mid cavity obstruction ( 4 , 5 ). In a systematic review, 90% of study population had hypertension, hyperlipidemia and smoking as predisposing risk factors ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

Mid-ventricular variant of dobutamine-induced stress cardiomyopathy

2015

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Introduction:Dobutamine stress testing is a commonly used modality in detecting and estimating the prognosis in coronary artery disease (CAD). Although it is well tolerated by most patients, adverse events have been reported. Rarely, transient wall motion abnormalities can occur in the absence of obstructive CAD to suggest stress cardiomyopathy.Case Presentation:We report a 48-year-old female with intermittent chest pain. Her physical exam, cardiac enzymes and transthoracic echocardiogram were unremarkable. She underwent dobutamine stress echocardiogram to rule out obstructive CAD. After 40 micrograms (mcg)/kg/minute and 0.5 mg atropine, she complained of intense chest pain and became hypertensive. Stress echocardiogram demonstrated mid-anterior and mid-septal hypokinesis. Emergent coronary angiogram demonstrated normal coronaries. Left ventricular angiogram in the right anterior oblique projection revealed mid-ventricular ballooning during systole with apical and basal hypercontractility. Patient demonstrated excellent recovery with expectant management.Conclusions:The mechanism of mid-variant of Dobutamine-induced stress cardiomyopathy remains unclear. We think that multiple mechanisms are involved and this risk should be considered in patients with comorbid psychiatric conditions and with use of centrally acting stimulants.

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Section: Discussionmentioning

confidence: 99%

Mid-ventricular variant of dobutamine-induced stress cardiomyopathy

2015

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“…Latent obstruction can be non-invasively detected by DSE. Thus, in cases that include TCM, DSE could be a useful tool for assessing the presence and significance of LV dynamic obstruction and for clinical decision-making, similarly to cases of HCM ( 12 ).…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy in a Patient with Previously Undiagnosed Hypertrophic Cardiomyopathy with Latent Obstruction

et al. 2018

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A 62-year-old woman with takotsubo cardiomyopathy (TCM) accompanied by cardiogenic shock due to the obstruction of left ventricular outflow tract (LVOT) and massive mitral regurgitation (MR) was admitted to the emergency department. After successful treatment with intensive care, dobutamine stress-echocardiography was performed, which reproduced a dynamic LVOT gradient, severe MR and cardiogenic shock. A histological examination obtained from the right ventricular septum demonstrated hypertrophied and bizarre myocytes, with myocyte disarray. Besides TCM, a diagnosis of preexisting hypertrophic cardiomyopathy with latent obstruction was made. She was discharged with medical therapy including a beta-blocker, which would not be routinely employed in the treatment of a patient with TCM.

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“…Symptomatic patients with LVOTO during dobutamine stress echocardiography did not have a greater incidence of takotsubo syndrome [10], nor an abnormal sympato-vagal balance [11]. Dobutamine stress test may induce LVOTO in patients with previous takotsubo, but it does not reproduce the morpho-functional features of the syndrome [12] at variance with cold pressor stress [13].…”

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confidence: 99%