Unequivocal interpretation of dobutamine stress echocardiography in low‐flow, low‐gradient aortic stenosis by right parasternal view

2021 ◽  
Author(s):  
Martina Setti ◽  
Stefano Nistri ◽  
Andrea Rossi ◽  
Francesca Mantovani ◽  
Flavio L. Ribichini ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Low Flow

scholarly journals Dobutamine Stress Echocardiography for Management of Low-Flow, Low-Gradient Aortic Stenosis

2018 ◽  
Vol 71 (5) ◽  
pp. 475-485 ◽  
Author(s):  
Mohamed-Salah Annabi ◽  
Eden Touboul ◽  
Abdellaziz Dahou ◽  
Ian G. Burwash ◽  
Jutta Bergler-Klein ◽  
...  
Keyword(s):  
Aortic Stenosis ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Low Flow

scholarly journals Outcome After Aortic Valve Replacement for Low-Flow/Low-Gradient Aortic Stenosis Without Contractile Reserve on Dobutamine Stress Echocardiography

2009 ◽  
Vol 53 (20) ◽  
pp. 1865-1873 ◽  
Author(s):  
Christophe Tribouilloy ◽  
Franck Lévy ◽  
Dan Rusinaru ◽  
Pascal Guéret ◽  
Hélène Petit-Eisenmann ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Low Flow ◽  
Contractile Reserve

P6483Predictors of contractile reserve on dobutamine stress echocardiography in patients with classical low-flow, low-gradient aortic stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Emer Egypto Rosa ◽  
H B Ribeiro ◽  
R O Samapio ◽  
T C Morais ◽  
M E E Rosa ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Severe Aortic Stenosis ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Delayed Enhancement ◽  
Low Flow ◽  
Functional Mitral Regurgitation

Abstract Background There is a lack of information on factors that influence contractile reserve (CR) on dobutamine stress echocardiography (DSE) in patients with classical low-flow, low-gradient aortic stenosis (LFLG-AS). Purpose This study sought to evaluate the predictors of CR in patients with LFLG-AS. Methods Prospective study including 43 consecutive LFLG-AS patients (aortic valve area [AVA] ≤1.0 cm2, mean transaortic gradient <40 mmHg, left ventricular ejection fraction [LVEF] <50%) with true severe aortic stenosis. All patients underwent dobutamine stress echocardiography and T1-mapping cardiac magnetic resonance (CMR). CR was defined as an increase ≥20% in the left ventricular stroke volume at peak stress. Patients with pseudo-severe aortic stenosis were excluded. Results All of the patients in the study had degenerative aortic stenosis, with a median age of 67 [60–74] years, most of them being male (83.7%). A high prevalence of comorbidities was found, highlighted by diabetes (42%), hypertension (70%), atrial fibrillation (25%) and coronary artery disease (38%). Mean transaortic gradient was 25 [20–33] mmHg, AVA was 0.88 [0.68–0.95] cm2, LVEF was 35 [28–43]% and 32.6% had moderate/severe functional mitral regurgitation. CMR myocardium extracellular volume fraction (ECV) was 28.8 [26.3–33.0] %, indexed ECV was 35.4 [25.0–41.2] ml/m2, 32.6% had positive transmural delayed-enhancement images and 25.6% had positive mesocardial delayed-enhancement images. On DSE, 30 patients (69.7%) had CR and 13 patients (30.3%) had no CR. Global longitudinal strain was 10 [7–12] %, Δ indexed flow rate was 25 [3–38] ml/m2.seg and Δ mean gradient was 10 [3–16] mmHg. By multivariate analysis, moderate/severe functional mitral regurgitation (HR 0.122, 95% CI 0.020–0.759, p=0.024) and AVA (HR 0.606, 95% CI 0.396–0.925, p=0.020 [for each increase of 0.05 cm2]) were the only factors associated with CR. ECV, indexed ECV and positive transmural or mesocardial delayed-enhancement images were not associated with CR in the univariate analysis. Conclusions In our study, the absence of moderate/severe functional mitral regurgitation and AVA were predictors of CR on DSE in patients with LFLG-AS. As AVA was smaller in patients with CR, our finding contradicts the hypothesis that more severe aortic stenosis could also contribute to the lack of CR. Other possible factors that are surrogate of myocardium fibrosis, as ECV, indexed ECV and positive delayed-enhancement images, were not associated with the absence of CR. Acknowledgement/Funding FAPESP

scholarly journals Dobutamine stress echocardiography in low-flow, low-gradient aortic stenosis with concomitant severe functional mitral regurgitation: a case report

2021 ◽  
Vol 5 (5) ◽  
Author(s):  
Kenichi Ishizu ◽  
Akihiro Isotani ◽  
Shinichi Shirai ◽  
Kenji Ando
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Aortic Stenosis ◽  
Stroke Volume ◽  
Stress Echocardiography ◽  
Dobutamine Stress Echocardiography ◽  
Dobutamine Stress ◽  
Low Flow ◽  
Valve Repair ◽  
Flow Reserve

Abstract Background  Dobutamine stress echocardiography (DSE) in classical low-flow, low-gradient (LFLG) aortic stenosis (AS) is recommended in recent guidelines to differentiate true-severe AS from pseudo-severe AS. However, DSE for patients with concomitant significant mitral regurgitation (MR) is often inaccurate or inconclusive. Case summary  A 73-year-old man with a history of coronary artery bypass grafting was referred to our institution with congestive heart failure. Transthoracic echocardiogram showed severe functional MR and LFLG AS. The results of DSE to determine the severity of AS were inconclusive owing to the absence of flow reserve, usually defined as stroke volume increase of ≥20%. In addition, calcium score by computed tomography scan was also inconclusive. Our heart team decided to reassess the severity of AS after percutaneous edge-to-edge mitral valve repair (PMVR), considering the patient’s high surgical risk. Percutaneous edge-to-edge mitral valve repair was uneventful, resulting in marked reduction of MR from severe to trivial. Dobutamine stress echocardiography after PMVR revealed true-severe AS with the presence of flow reserve. Transcatheter aortic valve implantation (TAVI) was performed, and the patient ambulatorily discharged. Discussion  The coexistence of significant AS may lead to overestimation of the severity of MR, and reportedly, concomitant MR improves in the majority of patients after TAVI, especially MR of functional aetiology. However, the coexistence of significant MR often leads to inconclusive DSE results because dobutamine stress may worsen MR and fail to increase the stroke volume. In our case, DSE after PMVR was useful to diagnose the true-severe AS for the patient with LFLG AS and severe functional MR.

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