Dobutamine Stress Echocardiography in Low-Gradient Aortic Stenosis

IF 5.4 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of the American Society of Echocardiography Pub Date : 2024-11-01 DOI:10.1016/j.echo.2024.06.017

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引用次数: 0

Abstract

Importance

Guidelines recommend the use of dobutamine stress echocardiography (DSE) in patients with low-gradient aortic stenosis (AS) and left ventricular ejection fraction (LVEF) <50%. However, a paucity of DSE data exists when LVEF >35%.

Objective

To examine the diagnostic accuracy of DSE in patients with low-gradient AS with a wide range of LVEF and to examine the interaction between the diagnostic accuracy of DSE and LVEF.

Design, Setting, and Participants

Patients with mean gradient <40 mm Hg, aortic valve area <1.0 cm², and stroke volume index ≤35 mL/m² undergoing DSE and cardiac computer tomography (C-CT) were identified from 3 prospectively collected patient cohorts and stratified according to LVEF: LVEF<35%, LVEF 35% to 50%, and LVEF>50%.

Exposure

Dobutamine stress echocardiography and C-CT were performed on patients with low-gradient AS.

Main Outcomes and Measures

Severe AS was defined as aortic valve calcification score ≥2,000 arbitrary units (AU) among men and ≥1,200 AU for women on C-CT.

Results

Of 221 patients included in the study, 78 (35%) presented with LVEF <35%, 67 (30%) with LVEF 35% to 50%, and 76 (34%) with LVEF >50%. Mean-gradient and aortic valve peak velocity during DSE showed significant diagnostic heterogeneity between LVEF groups, being most precise when LVEF <35% (both areas under the curve [AUC] = 0.90), albeit with optimal thresholds of 30 mm Hg and 377 cm/sec and a limited diagnostic yield in patients with LVEF ≥35% (AUC = 0.67 and 0.66 in LVEF 35% to 50% and AUC = 0.65 and 0.60 in LVEF ≥50%). Using guideline thresholds led to a sensitivity/specificity of 49%/84% for all patients with LVEF <50%.

Conclusion and Relevance

While DSE is safe and leads to an increase in stroke volume in patients with low-gradient AS regardless of LVEF, the association between DSE gradients and AS severity assessed by C-CT demonstrates important heterogeneity depending on LVEF, with the highest accuracy in patients with LVEF <35%.

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低梯度主动脉瓣狭窄的多巴酚丁胺应激超声心动图检查

重要性：指南建议在低梯度主动脉瓣狭窄（AS）和左室射血分数（LVEF）为35%的患者中使用多巴酚丁胺应激超声心动图（DSE）：研究低梯度主动脉瓣狭窄（AS）且左心室射血分数（LVEF）范围较宽的患者的 DSE 诊断准确性，并研究 DSE 诊断准确性与 LVEF 之间的相互作用：从三个前瞻性收集的患者队列中识别出平均梯度2、卒中容积指数≤35 mL/m2、接受DSE和心脏计算机断层扫描（C-CT）的患者，并根据LVEF进行分层；LVEF50%：主要结果和测量指标：重度强直性脊柱炎的定义是：C-CT上男性的AVC评分≥2000 AU，女性的AVC评分≥1200 AU：在纳入研究的 221 名患者中，78 人（35%）的 LVEF 为 50%。DSE 期间的平均梯度和 Vmax 在 LVEF 组间显示出明显的诊断异质性，在 LVEFC 时最为精确：虽然 DSE 是安全的，而且无论 LVEF 如何，都能增加低梯度 AS 患者的搏出量，但 DSE 梯度与 C-CT 评估的 AS 严重程度之间的关联显示出重要的异质性，这取决于 LVEF，其中 LVEF 为 50% 的患者的诊断准确性最高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of the American Society of Echocardiography 医学-心血管系统

CiteScore

9.50

自引率

12.30%

发文量

257

审稿时长

66 days

期刊介绍： The Journal of the American Society of Echocardiography(JASE) brings physicians and sonographers peer-reviewed original investigations and state-of-the-art review articles that cover conventional clinical applications of cardiovascular ultrasound, as well as newer techniques with emerging clinical applications. These include three-dimensional echocardiography, strain and strain rate methods for evaluating cardiac mechanics and interventional applications.