Left Ventricular Diastolic Filling Pressures During Dobutamine Stress Echocardiography: Relationship to Symptoms and Ischemia

Yoshie Nakajima, Garvan M Kane, Robert B. McCully, Steve R. Ommen, Patricia Pellikka

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

Background: Limited information exists regarding the relationship of left ventricular diastolic filling parameters measured by Doppler echocardiography during dobutamine stress echocardiography (DSE) and stress-induced symptoms or myocardial ischemia. Methods: To determine if there is an association between Doppler parameters of left ventricular filling and symptoms and ischemic wall motion abnormalities during DSE, the authors prospectively studied 219 patients (mean age, 66 ± 11 years; 55% men) referred for clinically indicated DSE. Pulsed-wave Doppler measurements of mitral inflow and medial annular tissue velocities at baseline, 20 μg/kg/min, peak stress, and recovery were made. Patients were classified as having stress-induced ischemia (n = 70) or no ischemia (n = 149) on the basis of the development of new or worsening wall motion abnormalities. Results: Patients who developed ischemia had lower baseline and peak stress diastolic annular tissue velocities (e′) (5.7 ± 1.9 vs 6.4 ± 1.9 cm/s at baseline, P = 0.02; 5.2 ± 1.6 vs 7.4 ± 2.4 cm/s at peak stress, P < .0001). At peak stress, the E/e′ ratio was higher (13.1 ± 6.3 vs 10.2 ± 4.2, P = .003); these differences persisted into recovery. The increase in E/e′ from 20 μg/kg/min to peak stress was greater (0.9 ± 2.1 vs -0.8 ± 3.1, P = .0009) in patients who developed symptoms during DSE and in patients who presented with dyspnea (0.3 ± 2.6 vs -1.0 ± 3.2, P = .02). The change in e′ velocity from baseline to peak stress, the change in E/e′ from baseline to recovery, known coronary artery disease, and the development of symptoms during DSE were independently associated with ischemia. Conclusions: The development of symptoms and myocardial ischemia during DSE are both associated with an increase in E/e′. The prognostic implications of elevated E/e′ during DSE have yet to be elucidated.

Original languageEnglish (US)
Pages (from-to)947-953
Number of pages7
JournalJournal of the American Society of Echocardiography
Volume22
Issue number8
DOIs
StatePublished - Aug 2009

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Stress Echocardiography
Ischemia
Blood Pressure
Myocardial Ischemia
Doppler Echocardiography
Dyspnea
Coronary Artery Disease

Keywords

  • Doppler
  • Ischemic heart disease
  • Stress echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Left Ventricular Diastolic Filling Pressures During Dobutamine Stress Echocardiography : Relationship to Symptoms and Ischemia. / Nakajima, Yoshie; Kane, Garvan M; McCully, Robert B.; Ommen, Steve R.; Pellikka, Patricia.

In: Journal of the American Society of Echocardiography, Vol. 22, No. 8, 08.2009, p. 947-953.

Research output: Contribution to journalArticle

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title = "Left Ventricular Diastolic Filling Pressures During Dobutamine Stress Echocardiography: Relationship to Symptoms and Ischemia",
abstract = "Background: Limited information exists regarding the relationship of left ventricular diastolic filling parameters measured by Doppler echocardiography during dobutamine stress echocardiography (DSE) and stress-induced symptoms or myocardial ischemia. Methods: To determine if there is an association between Doppler parameters of left ventricular filling and symptoms and ischemic wall motion abnormalities during DSE, the authors prospectively studied 219 patients (mean age, 66 ± 11 years; 55{\%} men) referred for clinically indicated DSE. Pulsed-wave Doppler measurements of mitral inflow and medial annular tissue velocities at baseline, 20 μg/kg/min, peak stress, and recovery were made. Patients were classified as having stress-induced ischemia (n = 70) or no ischemia (n = 149) on the basis of the development of new or worsening wall motion abnormalities. Results: Patients who developed ischemia had lower baseline and peak stress diastolic annular tissue velocities (e′) (5.7 ± 1.9 vs 6.4 ± 1.9 cm/s at baseline, P = 0.02; 5.2 ± 1.6 vs 7.4 ± 2.4 cm/s at peak stress, P < .0001). At peak stress, the E/e′ ratio was higher (13.1 ± 6.3 vs 10.2 ± 4.2, P = .003); these differences persisted into recovery. The increase in E/e′ from 20 μg/kg/min to peak stress was greater (0.9 ± 2.1 vs -0.8 ± 3.1, P = .0009) in patients who developed symptoms during DSE and in patients who presented with dyspnea (0.3 ± 2.6 vs -1.0 ± 3.2, P = .02). The change in e′ velocity from baseline to peak stress, the change in E/e′ from baseline to recovery, known coronary artery disease, and the development of symptoms during DSE were independently associated with ischemia. Conclusions: The development of symptoms and myocardial ischemia during DSE are both associated with an increase in E/e′. The prognostic implications of elevated E/e′ during DSE have yet to be elucidated.",
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author = "Yoshie Nakajima and Kane, {Garvan M} and McCully, {Robert B.} and Ommen, {Steve R.} and Patricia Pellikka",
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AU - Ommen, Steve R.

AU - Pellikka, Patricia

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N2 - Background: Limited information exists regarding the relationship of left ventricular diastolic filling parameters measured by Doppler echocardiography during dobutamine stress echocardiography (DSE) and stress-induced symptoms or myocardial ischemia. Methods: To determine if there is an association between Doppler parameters of left ventricular filling and symptoms and ischemic wall motion abnormalities during DSE, the authors prospectively studied 219 patients (mean age, 66 ± 11 years; 55% men) referred for clinically indicated DSE. Pulsed-wave Doppler measurements of mitral inflow and medial annular tissue velocities at baseline, 20 μg/kg/min, peak stress, and recovery were made. Patients were classified as having stress-induced ischemia (n = 70) or no ischemia (n = 149) on the basis of the development of new or worsening wall motion abnormalities. Results: Patients who developed ischemia had lower baseline and peak stress diastolic annular tissue velocities (e′) (5.7 ± 1.9 vs 6.4 ± 1.9 cm/s at baseline, P = 0.02; 5.2 ± 1.6 vs 7.4 ± 2.4 cm/s at peak stress, P < .0001). At peak stress, the E/e′ ratio was higher (13.1 ± 6.3 vs 10.2 ± 4.2, P = .003); these differences persisted into recovery. The increase in E/e′ from 20 μg/kg/min to peak stress was greater (0.9 ± 2.1 vs -0.8 ± 3.1, P = .0009) in patients who developed symptoms during DSE and in patients who presented with dyspnea (0.3 ± 2.6 vs -1.0 ± 3.2, P = .02). The change in e′ velocity from baseline to peak stress, the change in E/e′ from baseline to recovery, known coronary artery disease, and the development of symptoms during DSE were independently associated with ischemia. Conclusions: The development of symptoms and myocardial ischemia during DSE are both associated with an increase in E/e′. The prognostic implications of elevated E/e′ during DSE have yet to be elucidated.

AB - Background: Limited information exists regarding the relationship of left ventricular diastolic filling parameters measured by Doppler echocardiography during dobutamine stress echocardiography (DSE) and stress-induced symptoms or myocardial ischemia. Methods: To determine if there is an association between Doppler parameters of left ventricular filling and symptoms and ischemic wall motion abnormalities during DSE, the authors prospectively studied 219 patients (mean age, 66 ± 11 years; 55% men) referred for clinically indicated DSE. Pulsed-wave Doppler measurements of mitral inflow and medial annular tissue velocities at baseline, 20 μg/kg/min, peak stress, and recovery were made. Patients were classified as having stress-induced ischemia (n = 70) or no ischemia (n = 149) on the basis of the development of new or worsening wall motion abnormalities. Results: Patients who developed ischemia had lower baseline and peak stress diastolic annular tissue velocities (e′) (5.7 ± 1.9 vs 6.4 ± 1.9 cm/s at baseline, P = 0.02; 5.2 ± 1.6 vs 7.4 ± 2.4 cm/s at peak stress, P < .0001). At peak stress, the E/e′ ratio was higher (13.1 ± 6.3 vs 10.2 ± 4.2, P = .003); these differences persisted into recovery. The increase in E/e′ from 20 μg/kg/min to peak stress was greater (0.9 ± 2.1 vs -0.8 ± 3.1, P = .0009) in patients who developed symptoms during DSE and in patients who presented with dyspnea (0.3 ± 2.6 vs -1.0 ± 3.2, P = .02). The change in e′ velocity from baseline to peak stress, the change in E/e′ from baseline to recovery, known coronary artery disease, and the development of symptoms during DSE were independently associated with ischemia. Conclusions: The development of symptoms and myocardial ischemia during DSE are both associated with an increase in E/e′. The prognostic implications of elevated E/e′ during DSE have yet to be elucidated.

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