Influence of haemodynamics and myocardial ischaemia on Doppler transmitral flow in patients undergoing dobutamine echocardiography

Mazeika, P; Nadazdin, A; Oakley, Celia M.

doi:10.1093/oxfordjournals.eurheartj.a060373

Cited by 10 publications

(9 citation statements)

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“…In addition, increased heart rate has been shown previously to increase the rate of isovolumic relaxation (9, 30). These findings are consistent with previous reports showing increased diastolic myocardial performance and enhanced myocardial relaxation during β‐adrenergic stimulation in healthy subjects (10, 12, 13, 31, 32). Similar effects and improved ventricular function have been seen in coronary surgery patients with preserved left ventricular performance (33).…”

Section: Discussionsupporting

confidence: 93%

MR flow mapping of dobutamine‐induced changes in diastolic heart function

Paelinck

Lamb

Bax

et al. 2004

Magnetic Resonance Imaging

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Purpose:To evaluate the ability of MR flow mapping to measure changes in left ventricular filling during ␤-adrenergic stimulation. Materials and Methods:Mitral flow was measured in 10 healthy volunteers using conventional free breathing fastfield echo (FFE) with a spatial resolution of 2.7 ϫ 2.2 mm and a temporal resolution of 22 msec. The sequence was repeated during dobutamine infusion (20 g/kg/minute).Results: Stroke volume increased from a median of 99 mL (range: 68 -142 mL) (Note: values as presented are medians and ranges, throughout) to 114 mL (87-180 mL) (P Ͻ 0.05). Both early (E) peak filling rate (554 mL/second [433-497 mL] to 651 mL/second [496 -1096 mL/second]) (P Ͻ 0.05) and atrial (A) peak filling rate (238 mL/second [183-352 mL/second] to 341 mL/second [230 -538 mL/second]) (P Ͻ 0.05) increased. These changes, together with the increase in E acceleration peak and A deceleration peak, were consistent with facilitated myocardial relaxation. Conclusion:Conventional free breathing FFE has the ability to measure the effects of ␤-adrenergic stimulation on left ventricular filling.

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Section: Discussionsupporting

confidence: 93%

MR flow mapping of dobutamine‐induced changes in diastolic heart function

Paelinck

Lamb

Bax

et al. 2004

Magnetic Resonance Imaging

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“…The changes in haemodynamic parameters (heart rate, systolic and diastolic blood pressure, and rate–pressure product) were not significant in our study. These findings are consistent with those in previous studies [12,40,43].…”

Section: Discussionsupporting

confidence: 94%

“…In patients with CAD (group 2 and 3), there was a significant change in all Doppler transmitral variables from baseline to peak dose of dobutamine, as in previous studies [12,38,44], whereas in controls the peak early filling wave (E) and acceleration time of E was not significantly different from baseline to peak dose of dobutamine. The last data are not in keeping with those reported by two previous studies [38,44,45], in which a significant change of E wave from baseline to peak dose of dobutamine was observed.…”

Section: Discussionsupporting

confidence: 74%

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Transmitral pulsed‐Doppler echocardiography is a more accurate technique compared with two‐dimensional echocardiography using dobutamine, in patients with one vessel coronary artery disease

Bajraktari

Qirko

Fusco

et al. 2003

European J of Heart Fail

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To examine the effects of dobutamine on pulsed‐Doppler left ventricular filling indices and its utility for evaluation of CAD we studied 14 patients with normal coronary arteries (Group 1) and 39 patients with significant CAD (>70% diameter stenosis). Patients with coronary artery disease (CAD) were divided into two groups: patients with one‐vessel coronary disease (Group 2); and those with multivessel CAD (Group 3). After stopping cardioactive treatment, patients underwent incremental dobutamine stress (5, 10, 20, 30 and 40 μg/kg/min) during pulsed‐Doppler interrogation of diastolic filling with simultaneous heart rate and blood pressure measurements. The following transmitral Doppler variables were measured at baseline and at peak‐dose of dobutamine: peak early (E) and peak atrial (A) velocity; E/A ratio; acceleration time (AT) and deceleration time (DT) of E wave; isovolumic relaxation time (IVRT); and time–velocity integral (TVI). Two‐dimensional echocardiography was performed to detect regional asinergy and analyzed using a 16 segment model. Results: Normals and CAD patients showed comparable changes in heart rate and blood pressure (P=NS between groups). Intergroup analysis of the changes of transmitral flow showed the significant changes for these indices (P<0.001): E velocity (−2.78±10.04, 12.4±9.4 and 16.47±10.65 cm/s); AT of E wave (1.66±2.47, −5.2±1.38 and −4.66±2.39 m/s2); DT of E wave (−0.23±0.18, 0.2±0.2 and 0.2±0.28 m/s2); and TVI of transmitral flow (−1.26±0.7, 3.5±1.75 and 4.1±1.66 cm), respectively for Groups 1, 2 and 3. All other transmitral Doppler variables showed insignificant changes (P=NS) to dobutamine between groups. It is important that the significance of these changes were the same for patients with one‐vessel and those with multivessel coronary disease. In conclusion, during dobutamine stress testing, patients with CAD, had an abnormal response of these transmitral Doppler indices: E wave; AT of E wave; DT of E wave; and the TVI of transmitral flow. The abnormal responses of these Doppler indices of left ventricular filling are more accurate markers of significant single vessel CAD than new wall motion abnormalities during conventional DSE.

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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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Influence of haemodynamics and myocardial ischaemia on Doppler transmitral flow in patients undergoing dobutamine echocardiography

Cited by 10 publications

References 0 publications

MR flow mapping of dobutamine‐induced changes in diastolic heart function

MR flow mapping of dobutamine‐induced changes in diastolic heart function

Transmitral pulsed‐Doppler echocardiography is a more accurate technique compared with two‐dimensional echocardiography using dobutamine, in patients with one vessel coronary artery disease

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

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