O060 Clinical Significance of Dynamic Left Ventricular Outflow Tract Obstruction during Dobutamine Stress Echocardiography in Women with Chest Pain: Chest Pain in Korean Women’s Registry

Abstract

Introduction: Although dobutamine stress echocardiography (DSE) is frequently associated with dynamic left ventricular outflow tract obstruction (LVOTO), its clinical significance in women with chest pain is little known. Objectives: We assessed provked clinical significance of dynamic left ventricular outflow tract obstruction (LVOTO) by dobutamine stress echocardiography (DSE) in women with chest pain. Methods: Of 880 women patients from chest pain in Korean women’s registry (which was a multicenter registry of Korean women who visited in clinic for chest pain, 102 patients (57 10 years) without DSE-provoked ischemia were included. LVOTO was defined by the presence of a systolic flow with dagger-shaped late peaking and peak LVOT pressure gradient equal to or greater than 30mmHg in the LVOT or the midventricular area, not present at baseline and that disappeared after the recovery phase. The presence of CAD was defined as any epicardial coronary artery stenosis 50%. Treadmill test was also performed in all patients and Duke treadmill score (DTS) was calculated. Results: Fifty of 102 patients had no provoked LVOTO (group 1) and 52 (51%) had provoked LVOTO (group 2). Group 2 were older than group 1 (p1⁄40.001). Group 2 had smaller LV diameter but had larger LV mass index and relative wall thickness (all p<0.05). LV diastolic parameters including A velocity, DT and the ratio of E velocity and early diastolic mitral annular velocity (E/e’) were worse in group 2 (all p<0.05). In addition, peak LVOT pressure gradient was mostly related to the LV relative wall thickness (r1⁄40.405, p<0.001) and DT (r1⁄40.328, p1⁄40.001) even with adjusted by age. Of 102 patients, 83 had no CAD and all these findings were consistent with those of all patients. There were no differences of peak LVOT pressure gradient (p1⁄40.24) and prevalence of LVOTO (p1⁄40.73) between patients with CAD and with no CAD, but patients with LVOTO had lower DTS (3.90 4.14 vs 6.32 3.99, p1⁄40.02).