Abstract
BackgroundLow-dose dobutamine stress echocardiography (DSE) is indicated in patients with low flow (stroke volume index [SVi] < 35 ml/m2) low gradient (mean pressure gradient < 40 mmHg) and left ventricular ejection fraction (LVEF) < 50% aortic stenosis (AS) to assess LV contractile reserve (> 20% increase in SVi) and severity grade of AS. Severe AS is defined by a mean pressure gradient of 40 mmHg occurring at any time during the test when aortic valve area remains < 1.0 cm2.Case presentationThis case report highlights the utility of mitral annular systolic velocity (S′) by tissue Doppler imaging and peak LV outflow tract (LVOT) velocity as markers of LV intrinsic contractile function during DSE in a patient with low flow low gradient AS and reduced EF prior to transcatheter aortic valve implantation (TAVI).ConclusionsMitral annular S′ and peak LVOT velocities are reliable markers of LV intrinsic contractile function and should be incorporated into routine low-dose DSE.
Highlights
Low-dose dobutamine stress echocardiography (DSE) is indicated in patients with low flow low gradient and left ventricular ejection fraction (LVEF) < 50% aortic stenosis (AS) to assess Left ventricle (LV) contractile reserve (> 20% increase in stroke volume index (SVi)) and severity grade of AS
In routine clinical practice, a low dose DSE is essential for subcategorization of classical low flow low gradient AS into true severe and pseudo-severe, and assessment of contractile reserves, reflected by > 20% increase in SVi
We have recently shown that patients with moderate and severe AS had similar degree of aortic damage, as reflected by carotid-femoral pulse wave velocity [6]
Summary
Mitral annular S′ and peak LVOT velocities are reliable markers of LV intrinsic contractile function and should be incorporated into routine low-dose DSE.
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