Dobutamine Stress Echocardiography Research Articles

Evaluation of Left Ventricular Function in Patients with Coronary Slow Flow by the Dobutamine Stress Echocardiography.

The study aims to assess the changes to left ventricular (LV) function of patients with the coronary slow flow (CSF) in response to stress induced by low dose dobutamine. Based on coronary angiography (CAG) results, a total of 186 patients undergoing CAG for chest pain and suspected coronary heart disease were assigned to the CSF group (n = 142) and control group (n = 44). Patients in the CSF group underwent two-dimensional speckle-tracking echocardiography (STE) during the dobutamine stress test to evaluate LV systolic and diastolic functions. At rest, there were no statistically significant differences in LV peak systolic longitudinal strain (LS), LV peak systolic longitudinal strain rate (LSRs), LV peak early diastolic longitudinal strain rate (LSRed), LV circumferential strain (CS), or LV circumferential strain rate (CSRed) between the CSF and control groups. In the CSF group, LS and LSRs first increased as the infusion rate was increased to 10 μg/kg/min (all, p < 0.05), before decreasing at infusion rates of 15 and 20 μg/kg/min (all, p < 0.05). CS and CSRed increased in the CSF group at infusion rates of 5, 10, and 15 μg/kg/min, (all, p < 0.05), but decreased significantly at 20 μg/kg/min (all, p < 0.05). At rest, LV systolic and diastolic functions were comparable between the CSF and control groups. However, when blood flow to the heart muscles was insufficient, LSRed decreased first, followed by LS. In terms of sensitivity to myocardial ischemia, LS is a better strain parameter than CS.

S1286 Impact of Cardiovascular Disease on Liver Transplant Candidacy During Transplant Evaluation in a North American Center With High Obesity Prevalence

Introduction: There are no large studies that examined the impact of obesity and cardiovascular disease in patients undergoing evaluation for orthotopic liver transplantation (OLT). Methods: We retrospectively analyzed patients undergoing OLT evaluation between Jan 2012 and Nov 2021 in a liver transplant center in the Mid-West US. Results: 912 patients underwent OLT evaluation (59% males, mean age 57.4±10.5 years, Mean Na-MELD 18.7±8.7, 82% Caucasian and 8.6% African Americans) etiology of cirrhosis NASH (48.1%), alcohol (37.7%), and hepatitis C (18.5%). 31.8% and 41.7% were overweight and obese respectively. 261 (31.8%) underwent OLT, 554 (60.7%) were denied listing, and 51(5.6%) died during evaluation. 224 patients had coronary artery disease (CAD) and among them, 50% were denied OLT. Of all patients denied listing, 32% were denied OLT due to CAD. Comorbid medical conditions (30%), substance use (15%) and socioeconomic condition (19.3%) were other causes for denial for listing. 239 (26.2%) had metabolic syndrome (MS), of which 143 (59.8%) were denied OLT. Among patients denied, 55(10%) were morbidly obese (BMI >40). Gender, residential location(urban v/s rural), hypertension, diabetes, CAD, BNP levels, atrial fibrillation, chronic kidney disease, hyperlipidemia,MS,6-minute walk test (6MWT) did not correlate with transplant denial on univariate analysis (Table). Ethnicity (African American, p=0.03), vitamin-D deficiency (< 30 ng/ml) and BMI (p=0.038) had significant correlation. On multivariate analysis (MVA), BMI >30), (OR 0.71 [0.51-0.98], p = 0.04) and vitamin-D deficiency (OR 0.21 (0.15-0.29), p < .01) were independent predictors of denial. For predicting death during OLT evaluation, on univariate analysis, 6-minute walk test (6MWT), estimated pulmonary artery pressure (PAP) on transthoracic echocardiography, mean PAP on right heart catheterization, significant coronary obstruction on left heart catheterization were not predictors, but female gender and vitamin-D deficiency were predictors. On stratified analysis of patients denied listing due to CAD, the presence of MS (OR 2.1(1.3-3.5), p=0.003) was an independent predictor of denial, and normal BNP levels (< 100pg/ml) lowered the risk of denial (OR 0.42 (0.20-0.88), p=0.02). Conclusion: Obesity (BMI >40) and vitamin-D deficiency increased the risk of denial for transplant listing. Presence of metabolic syndrome increased the risk of denial for listing due to CAD and normal BNP levels (< 100pg/ml) significantly lowered the risk of denial from CAD. Table 1. - Univariate analysis for predictors of liver transplant denial and death in waiting list Transplant denial (p value) Death during evaluation (p value) Gender 0.09 0.04* Ethnicity 0.03* 0.21 Location (rural v/s urban) 0.15 0.5 Hypertension 0.86 0.41 Diabetes 0.81 0.98 BMI 0.04* 0.59 CAD 0.55 0.42 Chronic kidney disease 0.06 0.16 Atrial fibrillation 0.73 0.96 Hyperlipidemia 0.66 0.22 Metabolic syndrome 0.68 0.77 Vitamin-D deficiency < 0.01* < 0.01* 6 Minute Walk Test (6MWT) 0.67 0.56 BNP levels 0.19 0.65 Cardiac ejection fraction on echocardiography 0.58 Elevated estimated PAP 0.81 Elevated mean PAP 0.12 Computed tomography calcium score 0.35 Positive dobutamine stress echocardiography 0.68 Significant coronary obstruction in left heart catheterization 0.44

Additive effects of type 2 diabetes and metabolic syndrome on left ventricular torsion and linear deformation abnormalities during dobutamine stress echocardiography.

ObjectiveThe interplay between metabolic syndrome (MS) and type 2 diabetes (T2D) on regional myocardial mechanics and the potential additional effects of their combination remain poorly understood. In this context, we evaluated left ventricular (LV) torsion and linear deformation at rest and under dobutamine (DB) stress in patients with T2D, MS or both.MethodsThirty-nine T2D patients without MS (T2D), 37 MS patients free from T2D (MS), 44 patients with both T2D and MS (T2D-MS group) and 38 healthy patients (control group) were prospectively recruited. Speckle-tracking echocardiography (STE) was conducted at rest and low dose DB to evaluate LV myocardial longitudinal (LS) as well as circumferential (CS) strain and early diastolic strain rate (LSrd, CSrd) and twist-untwist mechanics.ResultsAt rest, MS, T2D and controls presented with similar resting LS and LSrd while significant lower values were obtained in T2D-MS compared to controls. DB revealed reduced LS, LSrd, CS and CSrd in MS and T2D groups compared to controls. In T2-MS, the decline in LS and LSrd established at rest was exacerbated under DB. Stress echocardiography revealed also lower basal rotation and subsequently lower twist in MS and T2D patients compared to controls. T2D-MS showed major impairments of apical rotation and twist under DB stress, with values significantly lower compared to the 3 other groups. From stepwise multiple linear regression analysis, epicardial adipose tissue for Δ (rest to DB) LS, numbers of MS factors for Δ CS and Δ Twist emerged as major independent predictors.ConclusionThese results demonstrate synergic and additive effects of T2D and MS on LV torsion and linear deformation abnormalities in asymptomatic patients with metabolic diseases. They also highlight the usefulness of speckle tracking echocardiography under DB stress in detecting multidirectional myocardial mechanics impairments that can remain barely detectable at rest, such as in isolated T2D or MS patients.

Value of myocardial deformation parameters for detecting significant coronary artery disease.

Introduction: The study aimed to evaluate the diagnostic value of global and regional myocardial deformation parameters derived from two-dimensional speckle-tracking echocardiography to detect functionally significant coronary artery stenosis. Methods: Dobutamine stress echocardiography and cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) were performed on 145 patients with a moderate and high probability of coronary artery disease (CAD) and LVEF≥55%. Significant CAD was defined as>50% stenosis of the left main stem,>70% stenosis in a major coronary vessel, or in the presence of intermediate stenosis (50-69%) validated as hemodynamically significant by CMRMPI. Patients were divided in two groups: non-pathological (48.3%) vs pathological (51.7%), according to CAG and CMR-MPI results. Afterwards, off-line speckle-tracking analysis was performed to analyse myocardial deformation parameters. Results: There were no differences in myocardial deformation parameters at rest between groups, except global longitudinal strain (GLS) and global radial strain (GRS) were significantly lower in the CAD (+) group: -21.3±2.2 vs.-16.3±2.3 (P<0.001) and 39.7±23.2 vs. 24.5±15.8 (P<0.001). GLS and regional longitudinal strain rate (SR) had the highest diagnostic value at high dobutamine dose with AUC of 0.902 and 0.878, respectively. At early recovery, GLS was also found to be the best myocardial deformation parameter with a sensitivity of 78%, specificity 67%, AUC 0.824. Conclusion: Global and regional myocardial deformation parameters are highly sensitive and specific in detecting functionally significant CAD. The combination of deformation parameters and WMA provides an incremental diagnostic value for patients with a moderate and high probability of CAD, especially the combination with regional longitudinal SR.

Tissue tracking of segmental strain as a predictor of provoked dynamic left ventricular outflow tract obstruction

BackgroundLeft ventricular outflow tract obstruction (LVOTO) is commonly observed in patients with hypertrophic cardiomyopathy (HCM) or left ventricular hypertrophy (LVH). Some patients develop LVOTO provoked by physical exertion, and hence termed dynamic LVOTO (DLVOTO). However, its precise prevalence and mechanism are still unclear. AimTwo-dimensional speckle tracking echocardiography (2D STE) seems to be helpful for the detection of early LV structural abnormalities. This study aimed to examine the possible role of segmental as well as global longitudinal strain in identifying DLVOTO non-HCM patients as detected by dobutamine stress echocardiography (DSE). Methods and resultsTwo hundred and fifty patients without structural heart disease had undergone conventional transthoracic echocardiography, 2D STE, and DSE. All patients with non-ischemic evidence were divided into two groups according to the DSE results; DLVOTO (+) and DLVOTO (−).Among 250 patients, 50 patients (36%) had shown DLVOTO after DSE (15 males, 35 females; mean age 55±7years). They were compared with 90 non -LVOTO obstruction patients (43 males, 47 females; mean age 57±6years). Based on multivariate logistic regression analysis, the independent predictors of provoked DLVOTO during DSE were resting basal septal longitudinal strain BS-LS average (p < 0.001), resting LA reservoir strain (p < 0.001), and systolic LVOT diameter (p = 0.03). Resting BS-LS average with cut-off - 17.5% was recognized as a critical indicator of DLVOTO, with sensitivity 78%, and specificity 95% (better than systolic LVOT diameter of sensitivity 76%, and specificity 15% and resting LA reservoir strain which showed poor AUC at ROC curve 0.007). ConclusionWe demonstrate that provoked LVOTO during DSE in non HCM symptomatic patients is directly correlated to resting regional LS, where the increased BS-LS of ≥ −17.5% was a key determinant of LVOT gradient provocation. Assessment of baseline BS-LS average might be a bedside simple tool for detection of patients with DLVOTO not able to do DSE.

Myocardial injury in stress echocardiography: Comparison of dobutamine, dipyridamole and dynamic stressors-single center study.

In stress echocardiography (SE), dipyridamole (DIP) and dynamic stress (ExSE) are reported as being safer than dobutamine stress echocardiography (DSE). We investigated whether these commonly used stressors cause myocardial injury, measured by high sensitivity troponin T (hsTnT). One hundred and thirty five patients (DSE n = 46, ExsE n = 46, DIP n = 43) with negative result of SE were studied. The exclusion criteria were known ischaemic heart disease (IHD), baseline wall motion abnormalities, left ventricle systolic dysfunction/regional wall motion abnormalities, septum/posterior wall ≥13 mm, diabetes/pre-diabetes, baseline hsTnT level ≥14 ng/L, baseline blood pressure ≥160/100 mmHg, peak pulmonary pressure ≥45mmHg, eGFR <1ml/s/1.73m2 , more than mild to moderate valvular disease and dobutamine side effects. HsTnT was measured before and 180 minutes after the test. All patients had low pre-test probabilities of having obstructive IHD. HsTnT increased in DSE, less so in ExSE, and was unchanged in the DIP group (∆hsTnT 9.4 [1.5-58.6], 1.1 [-0.9-15.7], -0.1 [-1.4-2.1] ng/L, respectively, p<0.001). In DSE, the ∆hsTnT was associated with peak dobutamine dose (r = 0.30, p = 0.045), test length (r = 0.43, p = 0.003) and atropine use (p<0.001). In ExSE, the hsTnT increase was more likely in females (p = 0.012) and the elderly (>65 years) (r = 0.32, p = 0.03); no association was found between atropine use (p = 0.786) or test length and ∆hsTnT (r = 0.10, p = 0.530). DSE is associated with myocardial injury in patients with negative SE, no injury was observed in DIP and only mild case in ExSE. Whether myocardial injury is causative of the higher reported adverse event rates in DSE remains to be determined.

Clinical relevance of chest pain during dobutamine stress echocardiography

Introduction: Chest pain is a common presentation in emergency units in daily life. Dobutamine stress echocardiography (DSE) was considered an early non-invasive method that help stratifying the risk for development of CVD. However, many patients experience chest pain shortly after DSE. Methods: 150 patients admitted to catheter unit in Cardiology Department at Al-Azhar university Hospitals between June 2021 and June 2022 with chest pain despite negative DSE. They all underwent coronary angiography. Results: 150 patients were included in the study. Their mean age was 50.99 ± 8.29 years old. 56.7% of patients were males. 24.7% of patients were diabetic. After PCA, 15.3% of patients had severe coronary arteries stenosis. We found that 6% of patients had severe stenosis of Left anterior descending and right coronary arteries (p&lt;0.001). In addition, DM with other risk factors was significantly associated with development of severe stenosis of coronary arteries (P&lt;0.001). Conclusion: 15.3 % of patients with chest pain following DSE had significant coronary arteries stenosis on PCA. DM was associated with that stenosis. That is why, in patients with negative DSE and chest pain, further investigations are required. Special emphasis should be directed to patients with more than one risk factor including diabetes mellitus.

Pulmonary Arterial Pressure Changes Under Dobutamine Stress Echocardiography in Non-Anemic Iron Deficient COPD Subjects.

PurposeNon-anemic iron deficiency (NAID) is common in COPD, and could induce functional/structural changes in the pulmonary vascular bed. Thus, we aimed to study, during resting and ambient oxygen conditions, the systolic pulmonary arterial pressure (sPAP) changes during dobutamine stress echocardiography (DSE) for NAID+ compared to NAID- subjects with COPD.Patients and MethodsWe analyzed 24 patients with COPD and evaluated their clinical parameters, including lung function and serum iron profile, followed by the changes in the sPAP under DSE.ResultsTen subjects with NAID+ were compared with fourteen NAID- subjects for sPAP measurement. At baseline, only left atrial volume was significantly different between groups (30±4 vs 23±5 mL*m2), respectively (p-value=0.002). For the right side, tricuspid annular plane systolic excursion (TAPSE) was similar between-groups (22±2 vs 20±4, p-value >0.05), at baseline. The sPAP (mmHg) changes were also not significantly different between groups (pre 32±14 vs peak 48±14 for NAID+ and pre 29±7 vs peak 43±10 for NAID-, Group p-value=0.400, Time p-value <0.0001, and Interaction p-value=0.606).ConclusionCOPD subjects with NAID do not show increased sPAP responses during DSE, compared with iron-replete subjects.

Comparison of Diagnostic Value Between STE+LDDSE and CMR-FT for Evaluating Coronary Microvascular Obstruction in Post-PCI Patients for STEMI.

BackgroundCoronary microvascular obstruction (CMVO) is closely associated with poor prognosis of ST-segment elevation myocardial infarction (STEMI) patients. However, data showing the comparison between cardiac magnetic resonance feature tracking (CMR-FT) and speckle tracking echocardiography (STE) combined with low-dose dobutamine stress echocardiography (LDDSE) in evaluating CMVO was scarcely available. We aimed to explore and compare the predictive value between CMR-FT and STE+LDDSE in detecting CMVO.MethodsSixty-one STEMI patients were executed cardiac magnetic resonance and echocardiography within the first 5–7 days after primary percutaneous coronary intervention (PCI). The myocardial strain analysis was performed in STE, STE+LDDSE, and CMR-FT, and strain parameters included radial strain (RS), circumferential strain (CS), and longitudinal strain (LS). ROC curves were performed to predict infarcted myocardium segments with CMVO.ResultsFinally, 324 infarcted myocardium segments were analyzed, including 100 infarcted segments with CMVO and 224 segments without CMVO by the gold standard assessment of late gadolinium-enhancement cardiac magnetic resonance imaging (LGE-CMR). The results showed that CS was generally superior to RS and LS in identifying CMVO. CS in CMR-FT facilitated the detection of CMVO, with a sensitivity, specificity, and accuracy of 78.00%, 81.25%, and 80.25%, respectively. The sensitivity, specificity, and accuracy of CS in STE combined with LDDSE were better than STE alone (76.00% vs 60.00%, 79.91% vs 64.29%, and 78.70% vs 62.96%, P < 0.05). In addition, CMR-FT is not superior to STE+LDDSE for detection of CMVO (P > 0.05).ConclusionLow-dose dobutamine can improve the clinical value of STE for evaluating CMVO in STEMI patients. Compared with CMR-FT, STE+LDDSE might be a better choice for STEMI patients because of its safety, convenience, and low-cost.

The evaluation of coronary microvascular obstruction in patients with STEMI by cardiac magnetic resonance T2-STIR image and layer-specific analysis of 2-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography.

This study was designed to assess coronary microvascular obstruction (MVO) in patients with acute ST-segment elevation myocardial infarction (STEMI) by cardiac magnetic resonance T2-weighted short tau inversion recovery (T2-STIR) image and layer-specific analysis of 2-dimensional speckle tracking echocardiography combined with low-dose dobutamine stress echocardiography (LDDSE-LS2D-STE). 32 patients were enrolled to perform cardiac magnetic resonance and echocardiography 5-7days after primary percutaneous coronary intervention. Infarcted myocardium was categorized into MVO+ group and MVO- group by late gadolinium enhancement as gold standard. At T2-weighted image, the area of hyper-intense region and hypo-intense core inside were marked as A1, A2 and A2/A1 > 0 represented MVO. Strain parameters were composed of longitudinal strain (LS), circumferential strain and radial strain at rest and dobutamine stress. There were 94 MVO+ segments, 136 MVO- segments according to gold standard. 96 segments had hypo-intense core at T2-STIR image. The sensitivity and specificity of T2-STIR in detecting MVO were 91.49 and 92.65%. Endocardial LS was superior to other parameters, and stress endocardial LS was higher than that of resting endocardial LS (sensitivity: 77.11% vs 72.29%, specificity: 93.28% vs 83.19%, AUC: 0.87 vs 0.82, P < 0.05). The combination of T2-STIR and stress endocardial LS in parallel test could improve sensitivity significantly (98.05% vs 91.49%). T2-STIR has higher diagnostic value in detecting MVO with some limitations. However, LDDSE-LS2D-STE with cost-effective and handling may be a good alternative to T2-STIR. It provides additional and reliable diagnostic tools to identify MVO in STEMI patients after reperfusion.

Prognostic Role of Cardiac Power in a Large Cohort of Patients with Normal Ejection Fraction Referred for Dobutamine Stress Echocardiography

Cardiac power reflects cardiac performance in terms of energy transferred by the left ventricle to the aorta per unit time. Peak stress cardiac power has been shown to predict outcomes in patients with reduced left ventricular ejection fraction (LVEF) and, more recently, in patients with normal LVEF referred for exercise stress echocardiography. The aim of this study was to evaluate the prognostic significance of cardiac power in patients with normal LVEF referred for dobutamine stress echocardiography. Data were studied from 15,576 patients with LVEF ≥ 50% and no significant valvular or right ventricular dysfunction who underwent dobutamine stress echocardiography. Cardiac power at rest and peak stress and power reserve (peak stress minus rest power) were calculated and normalized to left ventricular mass. Outcome end points were all-cause mortality and new-onset heart failure (HF). The mean age was 66±13years, and 49% patients were women. Resting and peak stress power/mass were 0.7±0.2 and 1.6±0.6W/100g left ventricular myocardium, respectively. During follow-up (median, 3.3years; interquartile range, 0.7-7.3years), 2,278 patients died and 2,137 developed HF. After adjusting for age, sex, comorbidities, and stress test results, lower peak stress power/mass was independently associated with mortality (adjusted hazard ratio, highest vs lowest quartile, 0.84; 95% CI, 0.74-0.95; P=.004) and HF at follow-up (adjusted hazard ratio, 0.67; 95% CI, 0.59-0.76; P&lt;.0001). Power reserve showed similar associations with outcomes. Assessment of cardiac power during dobutamine stress echocardiography in patients with normal LVEF provides valuable prognostic information regarding risk for mortality and future HF, in addition to stress test results. It is an important research tool to study cardiac performance, and the development of risk scores incorporating this novel index could be considered after further validation in prospective studies.

Passive Leg Raise Stress Echocardiography in Severe Paradoxical Low-Flow, Low-Gradient Aortic Stenosis

Dobutamine stress echocardiography is used to increase transvalvular flow in patients with low-flow, low-gradient aortic stenosis (AS). Dobutamine fails to increase the stroke volume index (SVI) in one third of patients. The aim of this study was to test whether passive leg raise (PLR) added to dobutamine could increase SVI and transvalvular flow in patients with severe paradoxical low-flow, low-gradient AS. Forty-five patients with apparent severe low-flow, low-gradient AS on the basis of traditional measurements were included. Twenty-five were categorized as belonging to the paradox group (left ventricular ejection fraction [EF]≥50%) and 20 to the low EF group (left ventricular EF&lt;50% or "classical" low-flow, low-gradient AS) for comparison. A four-step stress echocardiographic examination was performed: resting conditions (rest), PLR alone (PLR), maximal dobutamine infusion rate (Dmax), and a combination of Dmax and PLR (Dmax+PLR). Aortic valve area, SVI, and mean transvalvular flow were calculated using both the velocity-time integral (VTI) of left ventricular outflow tract and the Simpson method. Changes compared with rest and between the stress maneuvers were analyzed. In the paradox group, compared with rest, left ventricular end-diastolic volume was significantly decreased with Dmax but was completely restored with Dmax+PLR (rest vs Dmax vs Dmax+PLR: 61±15 vs 49±18mL [P&lt;.001] vs 61±18mL [P= NS]). The smallest increase in SVI in the paradox group was observed during Dmax (PLR vs Dmax vs Dmax+PLR: VTI, 38±4mL/m² [P&lt;.001] vs 36±7mL/m² [P=.019] vs 41±7mL/m² [P&lt;.001]; Simpson, 28±6mL/m² [P&lt;.001], 21±7mL/m² [P= NS], 27±7mL/m² [P= NS]). Compared with Dmax, Dmax+PLR was able to achieve a higher SVI (VTI, 36±7 vs 41±7mL/m² [P&lt;.001]; Simpson, 21±7 vs 27±7mL/m² [P&lt;.001]) and transvalvular flow with the Simpson method only (179±56 vs 219±56mL/sec, P&lt;.001), as well as a higher mean gradient (34±10 vs 39±12mm Hg, P=.003) and AVA with the Simpson method (0.64±0.21 vs 0.73±0.21cm², P=.026). In the low EF group, only SVI VTI (31±8 vs 35±7mL/m², P=.034) and mean gradient (29±12 vs 34±14mm Hg, P=.003) were higher with Dmax+PLR. The proportion of patients with SVI VTI ≥ 35mL/m² and increases of SVI VTI of &gt;20% compared with rest was highest with Dmax+PLR in both groups. Dobutamine decreases preload in paradoxical low-flow, low-gradient AS. Adding PLR counteracts this effect, resulting in increased SVI and flow (in one method). The combined stress maneuver allowed reclassification of some patients from severe to moderate AS and may therefore be useful in selected cases in this population in which severity is uncertain.

Dynamics of the Indicators of Low Dose Dobutamine Stress-Echocardiography under the Influence of High Doses of Atorvastatin in Patients with ST Elevation Myocardial Infarction

The aim of investigation: to study the effect of early administration high doses of atorvastatin in the acute period of STEMI on the indicators of low dose dobutamine stress-echocardiography and parameters of left ventricular remodeling. Material and Methods: The study included 164 patients with STEMI All patients underwent myocardial revascularization (TLT or PCI) within the first 6 hours. The 1st group included 82 patients who received basic therapy (atorvastatin 20 mg), the 2nd group included 82 patients who took a loading dose of atorvastatin (at a dose of 80 mg per day). Low dose dobutamine stress-echocardiography was performed to detect myocardial stunning after stabilization of the patients condition on 4–6 days of the disease. In addition to general clinical and conventional laboratory research methods, on the 1st day and on the 10th day of treatment, the level of CPK MB, ESR, the number of blood leukocytes, and the level of fibrinogen (FN) were determined. Results: On the 10th day of therapy in patients of both groups, there was a significant increase in ESR (in the 1st group by 2.1 times, in the 2nd - by 1.6 times) and a decrease in the level of CRP (by 3 and 2.65 times, respectively) compared to the first day. The dynamics of these indicators reflects the regular processes of the course of AMI. A more significant change in these parameters was recorded in patients of the 2nd group who took atorvastatin at a dose of 80 mg. At the same time, on the 10th day of AMI, the number of peripheral blood leukocytes significantly decreased in them (p&lt;0.05 when compared between groups). The number of dobutamine-responsive segments (segments with reversible dysfunction) in the group of patients treated with atorvastatin at a dose of 80 mg during myocardial reperfusion was significantly higher than in the control group (p&lt;0.05). Conclusion: It was revealed that conducting of myocardium reperfusion in infarct-related coronary artery with simultaneous use of atorvastatin’s high doses promoted the limitation of myocardial necrosis development, reducing ischemic and reperfusion injuries of myocardium and influenced on the formation of myocardial stunning zones which is a reversible disfunction. The use of atorvastatin in the dose of 80 mg/per day in the first hours after acute myocardial infarction development promotes the improvement of LV systolic indices, prevents the progressing of LV cavity postinfarction dilatation.

Dobutamine-Stress Echocardiography as a Predictor of Cardiac Function after Surgery for Aortic Valve Regurgitation with Poor Function

Dobutamine-Stress Echocardiography as a Predictor of Cardiac Function after Surgery for Aortic Valve Regurgitation with Poor Function

Exercise Echocardiography and Dobutamine Stress Echocardiography in The Assessment of Suspected or Known Coronary Artery Disease

Exercise echocardiography has become a significant tool of non-invasive valuation of coronary artery disease (CAD). The Exercise echocardiography and dobutamine stress echocardiography are widely applied methods with different clinical procedures and indications. Objective: To determine the exercise echocardiography and dobutamine stress echocardiography in the assessment of suspected or known coronary artery disease. Methods: 260 consecutive patients endured Stress Echocardiography in the Cardiology department of NICVD Karachi for one-year duration from January 2021 to December 2021. The treadmill was used for Exercise echocardiography applying the Bruce protocol. The standard method was applied for dobutamine stress echocardiography. The Stress Echocardiography was taken as positive on the basis of the appearance of worsening or new wall motion abnormalities. Results: Exercise echocardiography performed by 160 patients and DSE in 100 subjects with mean age of 47.21 and 53.10 years, correspondingly. Males were dominated in both groups. The both groups have similar risk factors. In the diagnosis of CAD, Exercise echocardiography was used more often than dobutamine stress echocardiography (61.5% vs 38.5%). The Viability tests have been carried out exclusively by DSE. The frequency of adverse events was 29% in dobutamine stress echocardiography and no one has side-effects in exercise echocardiography. Stress-related dysfunction of left ventricle was much communal in dobutamine stress echocardiography. Conclusion: Exercise Echocardiography is a better and safer non-invasive imaging method among subjects who can execute exercise, but DSE is further beneficial for pre-operative evaluation, viability and patients who are disabled physically for ergometer and treadmill exercise test.

Diagnostic performance of dobutamine stress echocardiography: A South African experience

Background. Dobutamine stress echocardiography (DSE) is a well-established modality for the diagnosis of coronary artery disease, but there are no reported diagnostic data in southern Africa. Objectives. To compare the safety, sensitivity and specificity of a South African (SA) DSE programme with larger, international series. Methods. All patients undergoing DSE from 2019 to 2021 at a single SA centre were included. A new wall motion abnormality (≥2 segments) signified inducible ischaemia. Results. A total of 106 patients (mean (standard deviation) age 61 (11) years, 68% male) were analysed. Six patients (6%) experienced chest pain during DSE and 4 (4%) developed an atrial arrhythmia. The sensitivity and specificity for epicardial coronary stenosis were 77% and 74%, respectively, changing to 82% and 72% when excluding those who had previous coronary artery bypass surgery. Conclusion. The sensitivity, specificity and safety of an SA DSE programme were comparable to international series. A DSE programme is feasible in a resource-constrained environment.

Cardiopulmonary exercise testing and efficacy of percutaneous coronary intervention: a substudy of the ORBITA trial.

AimsOxygen-pulse morphology and gas exchange analysis measured during cardiopulmonary exercise testing (CPET) has been associated with myocardial ischaemia. The aim of this analysis was to examine the relationship between CPET parameters, myocardial ischaemia and anginal symptoms in patients with chronic coronary syndrome and to determine the ability of these parameters to predict the placebo-controlled response to percutaneous coronary intervention (PCI).Methods and resultsPatients with severe single-vessel coronary artery disease (CAD) were randomized 1:1 to PCI or placebo in the ORBITA trial. Subjects underwent pre-randomization treadmill CPET, dobutamine stress echocardiography (DSE) and symptom assessment. These assessments were repeated at the end of a 6-week blinded follow-up period.A total of 195 patients with CPET data were randomized (102 PCI, 93 placebo). Patients in whom an oxygen-pulse plateau was observed during CPET had higher (more ischaemic) DSE score [+0.82 segments; 95% confidence interval (CI): 0.40 to 1.25, P = 0.0068] and lower fractional flow reserve (−0.07; 95% CI: −0.12 to −0.02, P = 0.011) compared with those without. At lower (more abnormal) oxygen-pulse slopes, there was a larger improvement of the placebo-controlled effect of PCI on DSE score [oxygen-pulse plateau presence (Pinteraction = 0.026) and oxygen-pulse gradient (Pinteraction = 0.023)] and Seattle angina physical-limitation score [oxygen-pulse plateau presence (Pinteraction = 0.037)]. Impaired peak VO2, VE/VCO2 slope, peak oxygen-pulse, and oxygen uptake efficacy slope was significantly associated with higher symptom burden but did not relate to severity of ischaemia or predict response to PCI.ConclusionAlthough selected CPET parameters relate to severity of angina symptoms and quality of life, only an oxygen-pulse plateau detects the severity of myocardial ischaemia and predicts the placebo-controlled efficacy of PCI in patients with single-vessel CAD.

The role of Dobutamine stress echocardiography in patients evaluated for liver transplant to predict latent cardiac disease

BackgroundDobutamine stress echocardiography (DSE) is a frequently used diagnostic tool in the cardiac assessment of patients evaluated for liver transplant. But it's precision to predict obstructive coronary artery disease (CAD) or cardiomyopathy has been subject to much debate. AimThe aim of this study is to assess the efficacy of DSE in diagnosing latent CAD in pre-liver transplant evaluation. MethodsThis is a prospective, single center, observational study. 109 patients with no prior history of CAD, and baseline normal left ventricular function, who underwent DSE as a part of pre-transplant work-up from December 2016 to June 2018 were included in our study. Left ventricular ejection fraction (LVEF) at peak stress, new wall motion abnormalities, achievement of contractile reserve (CR) were noted. Coronary angiography (CAG) was performed in patients who had either positive DSE or significant risk factors for CAD. Patients were observed post operatively up to their discharge for cardiac events. ResultsOnly one patient with positive DSE had CAD by angiogram (16.6%) whereas 46.4% (n=13) with negative DSE had CAD. Among the patients with normal epicardial coronaries, 83.3% (n=5) had positive DSE (‘p’=0.016). The sensitivity of DSE was 7%, specificity of DSE was 64%, positive predictive value was 16% and negative predictive value was 40 %. In-hospital mortality was 16% (n=15). Among them none had a positive DSE and all 6 patients with positive DSE were alive at the time of discharge (p= 0.26). ConclusionThe performance accuracy of DSE to detect latent CAD in patients undergoing liver transplant is poor.

The effect of empagliflozin on contractile reserve in heart failure: Prespecified sub-study of a randomized, double-blind, and placebo-controlled trial

Sodium-glucose co-transporter-2 inhibitors improve cardiac structure but most studies suggest no change in left ventricular (LV) systolic function at rest. Whether sodium-glucose co-transporter-2 inhibitors improve LV contractile reserve is unknown. We investigated the effect of empagliflozin on LV contractile reserve in patients with heart failure (HF) and reduced ejection fraction. Prespecified sub-study of the Empire HF trial, a double-blind, placebo-controlled, and randomized trial. Patients with LV ejection fraction (LVEF) ≤ 40% on guideline-directed HF therapy were randomized (1:1) to empagliflozin 10 mg or placebo for 12 weeks. The treatment effect on contractile reserve was assessed by low dose dobutamine stress echocardiography. In total, 120 patients were included. The mean age was 68 (SD 10) years, 83% were male, and the mean LVEF was 38 (SD 10) %. Respectively 60 (100%) and 59 (98%) patients in the empagliflozin and placebo groups completed stress echocardiography. No statistically significant effect of empagliflozin was observed for the contractile reserve assessed by LV-GLS (adjusted mean absolute change, empagliflozin vs placebo, 0.7% [95% confidence interval {CI} -0.5 to 2.0, P=.25]) or LVEF (adjusted mean absolute change, empagliflozin vs placebo, 2.2% [95% CI -1.4 to 5.8, P=.22]) from baseline to 12 weeks. LV-GLS contractile reserve was associated with accelerometer-measured daily activity level (coefficient -24 accelerometer counts [95% CI -46 to -1.8, P=.03]). Empagliflozin for 12 weeks added to guideline-directed HF therapy did not improve LV contractile reserve in patients with HF and reduced ejection fraction.

A new marker of risk for ischemic events

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Although dobutamine stress echocardiography (SE) has a high specificity, there is still a subset of patients (P) with false positive tests (FP) and their prognosis remains unclear. Purpose To identify the clinical and echocardiographic predictors of FP on SE and to evaluate the prognostic impact of FP on SE. Methods Retrospective study of 355 consecutive adult P who underwent SE for ischemia assessment over a one-year period: 134 (37,7%) women, 70,3 ± 0,57 years, body surface area (ASC) 1,85±0,01 cm2. Demographics, risk factors, clinical and laboratorial parameters and SE variables were evaluated. A FP result was defined as a positive SE for ischemia in the absence of ≥50% coronary artery (CA) lesion in a major artery of the corresponding coronary territory on subsequent angiography. P were divided into 2 groups regarding the presence (FP+) or the absence (FP0: 15,5% true positives, 79,7% true negatives, 0,3% false negatives ) of a FP result on SE and a comparative analysis was performed in order to characterize the groups and identify potencial predictors of FP results. P were followed for 2 years to assess acute myocardial infarction (AMI), hospitalization for acute heart failure (HF) and mortality (M). Results The FP rate was 4,5% (16P). Comparing to F0, P in group FP+ were younger (65,1±2,4 vs 70,5±0,6 years; p=0,045), baseline wall motion abnormalities were more frequent (75,0% vs 41,6%; p=0,009), had higher mean blood pressure values at rest (99,3±5,4 vs 82,0±1,3 mmHg; p=0,004) and at peak stage (140,3±5,6 vs 102,8±2,3 mmHg; p&amp;lt;0,001) and more often hypertensive response (37,5% vs 7,1%; p&amp;lt;0,001). There were no significant differences regarding previous CA disease, medication or complete left bundle branch block. By multivariate analysis, only mean blood pressure values at rest (OR 0,01; 95%CI 0,005-0,02; p=0,003) and at peak stage (OR 0,02; 95%CI 0,000-0,004; p=0,003) were independente predictors of FP. During follow-up was observed: AMI (FP+: 12,5% vs FP0: 1,8%, p=0,046), HF (FP+: 6,3% vs FP0: 11,5%, p=0,44) and M (FP+: 6,3% vs FP0: 6,2%, p=0,65). After adjustment for age, sex and comorbidities, there were no diferences between the groups regarding HF (p=0,45) and M (p=0,77), but the group FP+ mantained a higher rate of AMI (OR 0,21; 95%CI 0,065-0,354; p=0,005). Conclusion A FP result on SE is associated with higher mean blood pressure values during the test and with higher rates of AMI during follow-up. This result on SE should therefore be faced as a risk marker for ischemic events and can identify P that may benefit from aggressive risk factor control and careful clinical follow-up.