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European Heart Journal 1999 20(5):386-392; doi:10.1053/euhj.1998.1355
Copyright © 1999 by the European Society of Cardiology.
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Prevalence and significance of left ventricular outflow gradient during dobutamine echocardiography

D. Luria, M.W. Klutsteinf1, D. Rosenmann, J. Shaheen, S. Sergey and D. Tzivoni

Department of Cardiology, Jesselson Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel

revised September 22, 1998; accepted October 7, 1998

Abstract

Aims

This study investigated the clinical and physiological significance of the dynamic left ventricle outflow gradient observed in some patients during dobutamine stress echocardiography.

Methods

Three hundred and ninety-four consecutive patients completed dobutamine stress echocardiography using Doppler echocardiography to assess the presence of myocardial ischaemia and left ventricular outflow gradient. The prevalence of left ventricular outflow gradient was evaluated and correlated with echocardiographic and clinical findings. Fifteen patients with left ventricular outflow gradient during dobutamine infusion underwent exercise echocardiography for appearance of left ventricular outflow gradient.

Results

Sixty-nine of 394 (17·5%) patients developed a left ventricular outflow gradient of more than 36mmHg. In nine of them (13%) the anterior mitral valve leaflet had a systolic anterior motion. In 60 of the 69 patients (87%) there was a dynamic obstruction at the level of the papillary muscles. The mean intracavitary gradient was 75·4 (range 36–175)mmHg.There was no correlation between the presence or absence of a dobutamine stress echocardiography-induced left ventricle outflow gradient and chest pain or shortness of breath. In patients who developed a left ventricular outflow gradient ischaemic wall motion abnormalities occurred at a significantly lower frequency during dobutamine stress echocardiography (2·9 vs 16·4%P<0·001).None of the 15 patients who underwent exercise echo-cardiography developed significant left ventricular outflow gradient.

Conclusion

Left ventricular outflow gradient occurs occasionally during dobutamine stress echocardiography examination. Its presence is of no physiological or clinical significance.

Key Words: Dobutamine echocardiography • left ventricular outflow gradient

f1 Correspondence:Marc W. Klutstein, MD, Department of Cardiology, Jesselson Heart Center, Shaare Zedek Medical Center, POB 3235, Jerusalem 91031, Israel.

Opie, LH

References

  1. Drugs for the heart. Philadelphia: W. B. Saunders Company; 1994.
  2. Pellikka P, Oh J, Bailey K, Nichols B, Monahan K, Tajik A. Dynamic intraventricular obstruction during dobutamine stress echocardiography. A new observation. Circulation. 1992;86:1429–1432[Abstract/Free Full Text]
  3. Marcovitz P, Bach D, Mathias W, Shayna V, Armstrong W. Paradoxic hypotension during dobutamine stress echocardiography: clinical and diagnostic implications. J Am Coll Cardiol. 1993;21:1080–1086[Abstract]
  4. Weissman N, Nidorf S, Weyman A, Picard M. Effect of hydration on cavity obliteration during dobutamine stress echocardiography. Clin Cardiol. 1995;18:17–20[ISI][Medline]
  5. Sawada S, Segar D, Ryan T. Echocardiographic detection of coronary artery disease during dobutamine infusion. Circulation. 1991;83:1605–1614[Abstract/Free Full Text]
  6. Roger V, Pellikka P, Oh J, Miller F, Seward J, Tajik A. Stress echocardiography. Part I. Exercise echocardiography: techniques, implementation, clinical applications, and correlations. Mayo Clin Proc. 1995;70:5–15[ISI][Medline]
  7. Henien M, O’Sullivan C, Sutton G. Stress-Induced Left Ventricular Outflow Tract Obstruction: A Potential Cause of Dyspnea in the Elderly. J Am Coll Cardiol. 1997;30:1301–1307[Abstract]
  8. Rallidis L, Cokkinos P, Tousoulis D. Comparison of Dobutamine and Treadmill Exercise Echocardiography in Inducing Ischemia in Patients With Coronary Artery Disease. J Am Coll Cardiol. 1997;30:1660–1668[Abstract]
  9. Lever H, Karam R, Currie P. Hypertrophic cardiomyopathy in the elderly, distinctions from the young base on cardiac shape. Circulation. 1989;79:580–589[Abstract/Free Full Text]
  10. Goor D, Lillehei C, Edwards J. The ‘sigmoid septum’: Variation in the contour of the left ventricle outlet. Am J Roentgenol Rad Therapy Nucl Med. 1969;107:366–376[ISI][Medline]
  11. Lewis J, Maron B. Elderly patients with hypertrophic cardiomyopathy: A subset with distinctive left ventricular morphology and progressive clinical course late in life. J Am Coll Cardiol. 1989;13:36–45[Abstract]

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