Evaluation of the Response to Pharmacological Stress in Chronic Aortic Regurgitation

Abstract

We evaluated the hemodynamic response of patients with chronic aortic regurgitation and decreased ejection fraction (EF), mean value +/- SD (37 +/- 9), to dobutamine stress echocardiography (DSE). Eleven patients were studied with DSE. Nine patients were in New York Heart Association (NYHA) Class II and two in NYHA Class III. Ten patients received medical treatment in the only other periodic evaluation. With DSE in nine patients, a significant decrease in left ventricular end-diastolic and end-systolic diameters (LVEDD and LVESD) as well as LV end-diastolic and end-systolic volumes (LVEDV and LVESV) was documented in comparison to resting values. EF and fractional shortening (FS) improved significantly with DSE. Systolic wall stress (SWS) and pulmonary arterial systolic pressure (PASP) did not change. Average follow-up was 6.7 months. Three patients underwent valve replacement with mechanical prostheses. Two of them are in NYHA Class I and the other died of LV failure 3 days after surgery. One patient deteriorated beyond surgical treatment and was in NYHA Class II. The other seven patients remain in NYHA Class II and await valve replacement. In patients with chronic aortic regurgitation and depressed EF, the variables relevant to myocardial reserve appear to be EF, FS, LVEDD, LVESD, LVEDV, and LVESV.

Ecocardiograma sob estresse com dobutamina em pacientes assintomáticos com regurgitação aórtica

“…One patient whose EF did not increase with dobutamine died. The authors conclude that in patients with aortic regurgitation and decreased EF, dobutamine-induced elevation of EF and reduction of ventricular diameters and volumes are variables that indicate contractile reserve 11 . However, the samples were very small to enable any statistical analysis.…”

“…Radionuclide ventriculography is frequently performed in asymptomatic patients for the detection of early left ventricular dysfunction, although this study modality is a class IIb in the American guidelines 3 . Stress echocardiography has been often used for the diagnosis of coronary artery disease, and occasionally in the course of selected cases of heart valve diseases, such as aortic stenosis [4][5][6] , mitral stenosis 7,8 , and aortic regurgitation [9][10][11] .…”

The Emerging Role of Exercise Testing and Stress Echocardiography in Valvular Heart Disease

“…The observed magnitude of change in ejection fraction or stroke volume from rest to exercise is related not only to myocardial contractile function but also to severity of volume-overload and exercise-induced changes in pre-load and peripheral resistance (1). The validity of stress echocardiography in predicting outcome of patients with asymptomatic AR is limited by the small number of available studies (39,40) compared with the more extensive and consistent experience with exercise radionuclide angiography (41)(42)(43)(44). With the sparse data supporting the incremental prognostic value of stress echocardiography, this specific application is not recommended for routine clinical use (1).…”

Stress Doppler Echocardiography in Valvular Heart Diseases: Utility and Assessment

“…DSE can also be used but this is less physiological and data are more limited [21]. Exercise is the preferred method of evaluation.…”