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DIFFERENTIAL EFFECTS OF DOBUTAMINE AND EXERCISE ON LEFT VENTRICULAR VOLUMES DURING STRESS ECHOCARDIOGRAPHY
1784 JACC April 5, 2016 Volume 67, Issue 13
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) DIFFERENTIAL EFFECTS OF DOBUTAMINE AND EXERCISE ON LEFT VENTRICULAR VOLUMES DURING STRESS ECHOCARDIOGRAPHY Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: Emerging Applications of Echocardiography: Part II Abstract Category: 29. Non Invasive Imaging: Echo Presentation Number: 1231-259 Authors: Eliza Teo, Judy Hung, Jonathan Teoh, Evin Yucel, Daniel Bamira, Asaad Khan, Xin Zeng, Massachusetts General Hospital, Boston, MA, USA
Background: Stress echocardiography is deemed diagnostic with achievement of target heart rate (HR) (> 85% maximum predicted) or double product (DP) for exercise (ESE) and dobutamine (DSE). However both modalities affect the left ventricle (LV) differently. Exercise increases HR physiologically to increase myocardial workload whereas dobutamine exerts an inotropic effect but reduces afterload. Relying solely on HR or DP may not reflect stress induced changes on myocardial function from DSE. We sought to explore LV volumetric changes in DSE and ESE and to determine if submaximal DSE has comparable results with maximal ESE. Methods: : 417 patients with normal stress echocardiograms were included. Peak and rest LV volumes, dimensions and ejection fraction (EF) were measured. Patients were categorized into four groups depending on if target HR was achieved. Results: : DSE achieved greater EF and change in EF at peak stress than ESE. Compared to maximal ESE, submaximal DSE attained greater stroke volume, EF and change in EF and ESV despite lower DP with submaximal DSE. Parameter Peak HR % Max predicted HR Peak double product LV systolic dimension Δ (mm) Base EF (%) Peak EF (%) % EF Δ Peak EDVi (mL) EDV Δ (%) Peak ESVi (mL) ESV Δ (%) Peak SV (mL)
Max DSE n= 194
141 ± 10.1 ˆ 88.6 ± 4.2 ˆ 18025 ± 6694 ˆ -6.7 ± 4.3 63.6 ± 7.1 77 ± 6.1 19.7 ± 12.3 44.6 ± 13.3 ˆ -10.4 ± 15.1 10.3 ± 4.7 ˆ -36.6 ± 21.1 73.6 ± 20.8
Submax DSE n = 59 132 ± 11.1 *# 79 ± 4.1 *# 17491 ± 6948 *# -6.2 ± 4.3 *# 63.2 ± 6.8 75.8 ± 8.8 *# 20.4 ± 12.3 *# 52.1 ± 13.6 -12.8 ± 12 *# 13 ± 7.1 *# -34.1 ± 26.2 *# 74.9 ± 23.3 *
Max ESE n= 101 141 ± 11.1 89 ± 4.3 22070 ± 5108 -2.6 ± 4.6 62.8 ± 7.5 70.2 ± 7.1 12.3 ± 8.6 50.4 ± 13.4 -0.89 ± 15.7 15.3 ± 6.1 -19 ± 18.2 64.2 ± 18.4
Submax ESE n = 63 126.5 ± 14 77.4 ± 4.2 21175 ± 5030 -2.9 ± 4.6 63.5 ± 7.2 70.2 ± 7.2 11 ± 8.8 51.1 ± 11 -2.9 ± 15 15.5 ± 5.8 -18.4 ± 27.3 66.8 ± 15.6
* Significant difference between max ESE and sub DSE (p < 0.05) # Significant difference between sub DSE and sub ESE (p < 0.05) Significant difference between max DSE and sub DSE (p < 0.05) Conclusions: Dobutamine and exercise exert different effects on LV volumes and parameters of contractility. Compared to maximal ESE, submaximal DSE resulted in greater reduction in ESV and increase in EF, suggesting that similar information may be obtained despite not achieving the target HR. HR and DP parameters may not be ideal in DSE as determination of achievement of adequate stress as these do not account for the increase in contractility seen in DSE.
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) DIFFERENTIAL EFFECTS OF DOBUTAMINE AND EXERCISE ON LEFT VENTRICULAR VOLUMES DURING STRESS ECHOCARDIOGRAPHY Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 3:45 p.m.-4:30 p.m. Session Title: Emerging Applications of Echocardiography: Part II Abstract Category: 29. Non Invasive Imaging: Echo Presentation Number: 1231-259 Authors: Eliza Teo, Judy Hung, Jonathan Teoh, Evin Yucel, Daniel Bamira, Asaad Khan, Xin Zeng, Massachusetts General Hospital, Boston, MA, USA
Background: Stress echocardiography is deemed diagnostic with achievement of target heart rate (HR) (> 85% maximum predicted) or double product (DP) for exercise (ESE) and dobutamine (DSE). However both modalities affect the left ventricle (LV) differently. Exercise increases HR physiologically to increase myocardial workload whereas dobutamine exerts an inotropic effect but reduces afterload. Relying solely on HR or DP may not reflect stress induced changes on myocardial function from DSE. We sought to explore LV volumetric changes in DSE and ESE and to determine if submaximal DSE has comparable results with maximal ESE. Methods: : 417 patients with normal stress echocardiograms were included. Peak and rest LV volumes, dimensions and ejection fraction (EF) were measured. Patients were categorized into four groups depending on if target HR was achieved. Results: : DSE achieved greater EF and change in EF at peak stress than ESE. Compared to maximal ESE, submaximal DSE attained greater stroke volume, EF and change in EF and ESV despite lower DP with submaximal DSE. Parameter Peak HR % Max predicted HR Peak double product LV systolic dimension Δ (mm) Base EF (%) Peak EF (%) % EF Δ Peak EDVi (mL) EDV Δ (%) Peak ESVi (mL) ESV Δ (%) Peak SV (mL)
Max DSE n= 194
141 ± 10.1 ˆ 88.6 ± 4.2 ˆ 18025 ± 6694 ˆ -6.7 ± 4.3 63.6 ± 7.1 77 ± 6.1 19.7 ± 12.3 44.6 ± 13.3 ˆ -10.4 ± 15.1 10.3 ± 4.7 ˆ -36.6 ± 21.1 73.6 ± 20.8
Submax DSE n = 59 132 ± 11.1 *# 79 ± 4.1 *# 17491 ± 6948 *# -6.2 ± 4.3 *# 63.2 ± 6.8 75.8 ± 8.8 *# 20.4 ± 12.3 *# 52.1 ± 13.6 -12.8 ± 12 *# 13 ± 7.1 *# -34.1 ± 26.2 *# 74.9 ± 23.3 *
Max ESE n= 101 141 ± 11.1 89 ± 4.3 22070 ± 5108 -2.6 ± 4.6 62.8 ± 7.5 70.2 ± 7.1 12.3 ± 8.6 50.4 ± 13.4 -0.89 ± 15.7 15.3 ± 6.1 -19 ± 18.2 64.2 ± 18.4
Submax ESE n = 63 126.5 ± 14 77.4 ± 4.2 21175 ± 5030 -2.9 ± 4.6 63.5 ± 7.2 70.2 ± 7.2 11 ± 8.8 51.1 ± 11 -2.9 ± 15 15.5 ± 5.8 -18.4 ± 27.3 66.8 ± 15.6
* Significant difference between max ESE and sub DSE (p < 0.05) # Significant difference between sub DSE and sub ESE (p < 0.05) Significant difference between max DSE and sub DSE (p < 0.05) Conclusions: Dobutamine and exercise exert different effects on LV volumes and parameters of contractility. Compared to maximal ESE, submaximal DSE resulted in greater reduction in ESV and increase in EF, suggesting that similar information may be obtained despite not achieving the target HR. HR and DP parameters may not be ideal in DSE as determination of achievement of adequate stress as these do not account for the increase in contractility seen in DSE.