The clinical impact of dynamic intraventricular obstruction during dobutamine stress echocardiography

Barletta, Giuseppe; Bene, Maria Riccarda Del; Gallini, Chiara; Salvi, S.; Costanzo, Egidio Natalino; Masini, Michele; G, Galeota; Fantini, F

doi:10.1016/s0167-5273(99)00081-9

Cited by 34 publications

(31 citation statements)

References 23 publications

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“…6 In contrast, Barletta et al proposed that intraventricular obstruction during DSE is clinically significant in patients without CAD with unexplained reduced effort tolerance. 7 In the present study, 30 patients (29.5%) had chest pain or chest discomfort during DSE, and 24 of these 30 patients (80%) had significant DLVOTO. In other words, the prevalence of chest pain/discomfort during DSE was significantly higher in the DLVOTO group than in the non-DLVOTO group (24 of 52 [46.2%] vs. 6 of 50 [12%], P<0.001).…”

Section: Discussionsupporting

confidence: 47%

“…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.…”

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confidence: 89%

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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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Section: Discussionsupporting

confidence: 47%

mentioning

confidence: 89%

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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“…The condition of DLVOTO in the absence of hypertrophic obstructive cardiomyopathy (HCM) has been previously described in stress echocardiography (dobutamine [4][5][6][7][8][9][10][11][12][13] and exercise [14]), following aortic [15][16][17] or mitral valve replacement [18][19][20][21][22][23], and in acute coronary syndromes [24,25].…”

Section: Introductionmentioning

confidence: 99%

Beta-blocker therapy for dynamic left ventricular outflow tract obstruction induced by exercise

Cabrera-Bueno

García‐Pinilla

Gómez‐Doblas

et al. 2007

International Journal of Cardiology

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“…Following studies didn't confirm this hypothesis and identified predisposing factors to such a response in female sex, baseline small LV dimensions and normal LV EF [11,20]; although presence of DLVO reduced DSE sensitivity, especially for single-vessel disease, it showed a favorable long-term prognostic value [10]. Clinical relevance of DLVO remains a topic [21] of debate, for previous conflicting reports [20,22,23].…”

Section: Dse and Dlvomentioning

confidence: 99%

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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The clinical impact of dynamic intraventricular obstruction during dobutamine stress echocardiography

Cited by 34 publications

References 23 publications

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

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

Beta-blocker therapy for dynamic left ventricular outflow tract obstruction induced by exercise

Left ventricular cavity obliteration during dobutamine stress echocardiography in diabetic patients

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