Safety and feasibility of dobutamine stress echocardiography in symptomatic high gradient aortic stenosis patients scheduled for transcatheter aortic valve implantation

Abstract

Purpose We aimed to study the safety and feasibility of low‐dose dobutamine stress echocardiography in a symptomatic high gradient aortic stenosis population scheduled for transfemoral transcatheter aortic valve implantation (TAVI) and to quantify left ventricular (LV) flow reserve. Methods Fifty patients underwent dobutamine stress echocardiography with 5 minutes increments of 5 μg/kg/min up to 20 μg/kg/min until the heart rate increased ≥20 beats/min from baseline or exceeded 100 beats/min. Other criteria for discontinuing the infusion were major adverse events: ventricular arrhythmia, persistent supraventricular arrhythmia, pulmonary edema, chest pain with significant ST‐changes, or minor events: ST‐changes, drop in systolic blood pressure >30 mmHg, mild chest pain, and/or dyspnea. LV flow reserve was defined as an increase in stroke volume ≥20% during the test. Results Of 50 patients, 45 completed the test according to protocol. No patient had major adverse event. Five patients experienced minor side effects: mild chest pain/dyspnea in three, self‐terminating atrial flutter in one, and decrease in blood pressure in one. Significant LV flow reserve was observed in 20 patients (40%). Conclusion Low‐dose dobutamine stress test appeared safe and feasible patients with high gradient aortic stenosis, and showed LV flow reserve in a minority of them.

The role of stress echocardiography in transcatheter aortic valve implantation and transcatheter edge-to-edge repair era: A systematic review

“…Barbash et al ( 21 ) in 61 patients with LFLG AS undergoing TAVI showed that CR assessed with dobutamine SE did not predict LVEF recovery but did predict lower mortality ( 21 ). Saevik et al ( 22 ) demonstrated safety and feasibility of low-dose dobutamine SE in 50 patients with high gradient AS, showing reduced CR in 40% of them ( 22 ). Finally D’Andrea et al ( 23 ) showed that a cutoff value for left ventricle global longitudinal strain (LV GLS) of >−12% well distinguished patients without significant CR and with lack of positive remodeling after TAVI at follow-up ( 23 ) ( Table 2 ).…”

“…In classic high-gradient AS, SE is not usually performed and there is little data about it. Saevik et al ( 22 ) published an initial analysis of a cohort of patients with symptomatic high-gradient AS and LVEF > 40% in which pre-procedural CR was evaluated with a low-dose DSE pre-TAVI. The aim was to evaluate the safety and feasibility of the DSE in this subset of patients and look for the presence of CR ( 22 ).…”

“…Saevik et al ( 22 ) published an initial analysis of a cohort of patients with symptomatic high-gradient AS and LVEF > 40% in which pre-procedural CR was evaluated with a low-dose DSE pre-TAVI. The aim was to evaluate the safety and feasibility of the DSE in this subset of patients and look for the presence of CR ( 22 ). Of the 50 patients enrolled, 45 (90%) completed the protocol.…”

“…Of the 50 patients enrolled, 45 (90%) completed the protocol. Only 10% of them reported minor events that caused test interruption ( 22 ). Symptoms rapidly regressed with dobutamine suspension ( 22 ).…”

“…Only 10% of them reported minor events that caused test interruption ( 22 ). Symptoms rapidly regressed with dobutamine suspension ( 22 ).…”