Normal Coronary Angiogram and Dobutamine‐Induced Left Ventricular Obstruction During Stress Echocardiography: A Higher Hemodynamic Responsiveness to Dobutamine

Christiaens, Luc; Duplantier, C.; Allal, J; Donal, Erwan; Nanadoumgar, Hoda; Barraine, R; Coisne, D.

doi:10.1046/j.1540-8175.2001.00285.x

Cited by 29 publications

(17 citation statements)

References 11 publications

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“…In this study we excluded patients with ascertained CAD that were included in several previous reports and are less likely to develop DLVO; in fact, previous ischemic episodes frequently determine LV enlargement and baseline wall motion abnormalities, with reduced LV EF, a pattern that often precludes DLVO development. Our results were comparable with two previous studies [12,13], that included only patients evaluated for chest pain, with angiographically normal coronary arteries. They found a DLVO prevalence similar to what we found, but they were not able to demonstrate any difference in LV dimensions and function between patients with and without DLVO, a discrepancy with our work that could be due to the smaller size of their study populations.…”

Section: Dse and Dlvosupporting

confidence: 90%

“…In patients without CAD, DLVO prevalence seems to be significantly higher [12,13]; although from a prognostic point of view, DLVO yields a excellent value, because it seems to indicate a fully preserved LV contractile reserve, it has been reported a reduction in diagnostic accuracy, especially in presence of a coronary one-vessel disease [10].…”

Section: Introductionmentioning

confidence: 98%

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Left ventricular cavity obliteration during dobutamine stress echocardiography in diabetic patients

Innocenti

Baroncini

Agresti

et al. 2011

Int J Cardiovasc Imaging

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Prevalence of dynamic left ventricular outflow tract obstruction (DLVO) during dobutamine stress-echo (DSE) seems disproportionally high among diabetic patients. We retrospectively identified 212 diabetic (D?) and 212 non diabetic (D-) subjects, who underwent DSE for suspected coronary artery disease (CAD); we evaluated DSE-induced DLVO prevalence and correlates. During DSE, 105 patients in D? (50%) and 83 in D-group (39%, P = 0.032) developed a DLVO, with similar maximum gradient (94 ± 49 mmHg in D? vs. 86 ± 49 mmHg in D-, P = NS). D? and D-patients with DLVO showed reduced LV end-diastolic and end-systolic dimension. Compared with diabetic subjects without DLVO, diabetic patients with DLVO had higher left ventricular (LV) ejection fraction (EF), lower LV mass index; diastolic function was normal in a higher proportion of cases. Non diabetic patients with moderate or severe DLVO had higher LV EF compared with patients without DLVO. At multivariate analysis, in D? patients, the only independent predictor was a smaller LV end-diastolic diameter (HR 0.779, CI 0.655-0.926, P = 0.005); in D-patients lower age (HR 0.878, CI 0.806-0.957, P = 0.003), higher LV EF (HR 1.087, CI 1.003-1.177, P = 0.042) and lower peak WMSI (HR 0.017, CI 0.001-0.325, P = 0.007) were associated to presence of DLVO. In D? patients, during a median follow-up of 924 ± 134 days, we observed 11 new cardiac events, only 1 in patients with DLVO (P = 0.0041). DSE-provoked DLVO had a very high prevalence in patients evaluated for suspected CAD, especially among diabetic patients; echocardiographic predictors were a reduced LV dimension in D? and a preserved systolic function, both at rest and at peak stress, in D-patients.

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Section: Dse and Dlvosupporting

confidence: 90%

Section: Introductionmentioning

confidence: 98%

Left ventricular cavity obliteration during dobutamine stress echocardiography in diabetic patients

Innocenti

Baroncini

Agresti

et al. 2011

Int J Cardiovasc Imaging

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“…4-6 In one study, DLVOTO during DSE developed in 20 of 52 patients (38%) with normal coronary arteries and unexplained chest pain. 16 In the present study, 51% of the patients had DLVOTO, which is significantly higher than in other published studies. One possible explanation for this is that we studied women only.…”

Section: Disclosurescontrasting

confidence: 70%

Clinical Significance of Dynamic Left Ventricular Outflow Tract Obstruction During Dobutamine Stress Echocardiography in Women With Suspected Coronary Artery Disease

Park

Kim

et al. 2015

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp intraventricular obstruction during DSE was clinically significant in patients without CAD who have unexplained reduced effort tolerance. 7 The dynamic LV cavity obliteration or LVOTO seemed to be associated with smaller LV and a greater LV wall thickness in patients who underwent DSE for the evaluation of chest pain and preoperative evaluation for non-cardiac surgery. 8 These studies, however, were performed in heterogeneous participants with different reasons for undergoing DSE, and the relationship between DLVOTO and symptoms has not been well investigated. Moreover, DLVOTO during DSE is more prevalent in female subjects, 8 and a considerable number of women have effort-induced and unexplained chest symptoms such as angina and shortness of breath with no significant evidence of angiographic CAD. obutamine stress echocardiography (DSE) is widely used as an alternative stress imaging test for the evaluation of suspected or known coronary artery disease (CAD). 1-3 The development of dynamic left ventricular outflow tract obstruction (DLVOTO) in states of hypercontractility is not infrequently observed during DSE. Although several studies investigating DLVOTO during DSE have been conducted, the clinical significance of DSE-provoked DLVOTO remains controversial. Pellikka et al suggested that the development of dynamic intraventricular obstruction leads to hypotension during DSE, 4 but this was not found in another study. 5 Furthermore, the development of DLVO gradient during DSE was not associated with dobutamine induced-chest pain or shortness of breath.

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“…[18][19][20] In this study, more patients in the L-LVOTO (+) group developed symptoms of chest pain, chest pressure, chest discomfort, dyspnea, and near syncope; however, the difference between the two groups was not statistically significant. All patients in this study had malignancies; therefore, they may have lower performance status that could reflect the lower incidence of chest symptoms compared to previous studies.…”

Section: Discussionmentioning

confidence: 85%

“…All patients in this study had malignancies; therefore, they may have lower performance status that could reflect the lower incidence of chest symptoms compared to previous studies. 10,[18][19][20] Intriguingly, not all patients with high LVOT velocity (higher than 4 m/second) exhibited chest symptoms. Apparently compromised cardiac performance may relate to the occurrence of the symptoms.…”

Section: Discussionmentioning

confidence: 99%

Basic Echocardiographic Features of Patients With Latent Left Ventricular Outflow Tract Obstruction Without Left Ventricular Hypertrophy

et al. 2012

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SummaryLeft ventricular outflow tract obstruction (LVOTO) is commonly observed in patients with hypertrophic cardiomyopathy (HCM) or left ventricular hypertrophy (LVH). While some patients develop LVOTO at rest, it can also be provoked by physical exertion, and hence termed latent LVOTO (L-LVOTO). Recent reports demonstrated that L-LVOTO develops not only in LVH patients, but also in patients without LVH (non-LVH). However, the prevalence and clinical prognosis of non-LVH patients with L-LVOTO are not yet elucidated. In this study, we retrospectively investigated the echocardiographic features of patients with malignancy who underwent dobutamine stress echocardiography (DSE) to evaluate preoperative cardiac risk. One hundred ninety-nine patients were found not to have LVH or coronary artery disease. Among them, 106 patients exhibited L-LVOTO after DSE. We next compared the baseline echocardiographic features of L-LVOTO (+) patients with those of L-LVOTO (-) patients, and identified the left ventricular outflow tract (LVOT) ratio (systolic LVOT diameter/diastolic LVOT diameter) as a significant predictor of L-LVOTO. An LVOT ratio ≤ 0.83 was the best cutoff value to detect the presence of L-LVOTO, with a sensitivity of 81.1% and specificity of 80.6%. Overall, L-LVOTO was found to develop in almost half of non-LVH patients with malignancy. In addition, the baseline LVOT ratio was strongly related to the presence of L-LVOTO in non-LVH patients. Therefore, patients with dynamic LVOT narrowing may benefit from DSE to detect the presence of L-LVOTO. (Int Heart J 2012; 53: 230-233) Key words: Latent left ventricular outflow tract obstruction, Dobutamine stress echocardiography L eft ventricular outflow obstruction (LVOTO) occurs in about 25% of patients with hypertrophic cardiomyopathy (HCM). 1,2) LVOTO in HCM causes cardiovascular events such as angina, syncope, and heart failure, and is associated with an adverse clinical prognosis.1,2) While some HCM patients do not develop LVOTO at rest, it can be induced by stressors such as exercise or pharmacological stimulation, and has thus been termed latent LVOTO (L-LVOTO).3) L-LVOTO can be even provoked in patients without HCM or significant left ventricular hypertrophy (non-LVH). 4,5) Although L-LVOTO in non-LVH patients has a potential to induce cardiovascular events, the prevalence, clinical course, and prognosis of L-LVOTO in non-LVH patients still remain elusive. Therefore, such patients have to be followed carefully and their clinical outcome characterized.While one useful modality for detecting L-LVOTO is dobutamine stress echocardiography (DSE), 6) it cannot be performed easily in all hospital settings. Accordingly, there is a need for identification of the basic echocardiographic features that suggest the presence of L-LVOTO in non-LVH patients.In this study, we retrospectively investigated the baseline echocardiographic characteristics of non-LVH patients, andshowed that the dynamics of the left ventricular outflow dimension are strongly related to the presence ...

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Normal Coronary Angiogram and Dobutamine‐Induced Left Ventricular Obstruction During Stress Echocardiography: A Higher Hemodynamic Responsiveness to Dobutamine

Abstract: Dynamic LVO is common during DE in a population of patients with angina-like chest pain without epicardial CAD and is associated with a higher hemodynamic responsiveness to dobutamine.

Cited by 29 publications

References 11 publications

Left ventricular cavity obliteration during dobutamine stress echocardiography in diabetic patients

Left ventricular cavity obliteration during dobutamine stress echocardiography in diabetic patients

Clinical Significance of Dynamic Left Ventricular Outflow Tract Obstruction During Dobutamine Stress Echocardiography in Women With Suspected Coronary Artery Disease

Basic Echocardiographic Features of Patients With Latent Left Ventricular Outflow Tract Obstruction Without Left Ventricular Hypertrophy

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