Safety and feasibility of dobutamine stress echocardiography in symptomatic high gradient aortic stenosis patients scheduled for transcatheter aortic valve implantation

• Published in: Journal of clinical ultrasound Vol. 49; no. 1; pp. 38 - 48
• Main Authors: Sævik, Marte, Beitnes, Jan O., Aaberge, Lars, Halvorsen, Per S.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-01-2021; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Aorta; Aortic stenosis; Aortic valve; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; Arrhythmia; Blood pressure; Blood Pressure - physiology; Cardiac arrhythmia; Cardiotonic Agents - pharmacology; Chest; Dobutamine - pharmacology; dobutamine stress echocardiography; Dyspnea; Echocardiography; Echocardiography, Stress - methods; Edema; feasibility; Feasibility Studies; Female; flow reserve; Flutter; Heart rate; Heart Rate - physiology; Heart valves; Humans; Implantation; Male; Pain; Preoperative Care - methods; Respiration; Safety; Severity of Illness Index; Side effects; Stenosis; Stress; Stroke; Stroke volume; Stroke Volume - physiology; Transcatheter Aortic Valve Replacement; Ultrasonic imaging; Ventricle; feasibility; aortic stenosis; dobutamine stress echocardiography; safety; flow reserve
• ISSN: 0091-2751; 1097-0096
• DOI: 10.1002/jcu.22915

Purpose
We aimed to study the safety and feasibility of low‐dose dobutamine stress echocardiography in a symptomatic high gradient aortic stenosis population scheduled for transfemoral transcatheter aortic valve implantation (TAVI) and to quantify left ventricular (LV) flow reserve.
Methods
Fifty patients underwent dobutamine stress echocardiography with 5 minutes increments of 5 μg/kg/min up to 20 μg/kg/min until the heart rate increased ≥20 beats/min from baseline or exceeded 100 beats/min. Other criteria for discontinuing the infusion were major adverse events: ventricular arrhythmia, persistent supraventricular arrhythmia, pulmonary edema, chest pain with significant ST‐changes, or minor events: ST‐changes, drop in systolic blood pressure >30 mmHg, mild chest pain, and/or dyspnea. LV flow reserve was defined as an increase in stroke volume ≥20% during the test.
Results
Of 50 patients, 45 completed the test according to protocol. No patient had major adverse event. Five patients experienced minor side effects: mild chest pain/dyspnea in three, self‐terminating atrial flutter in one, and decrease in blood pressure in one. Significant LV flow reserve was observed in 20 patients (40%).
Conclusion
Low‐dose dobutamine stress test appeared safe and feasible patients with high gradient aortic stenosis, and showed LV flow reserve in a minority of them.