DOBUTAMINE STRESS DOPPLER-ECHOCARDIOGRAPHY - REPRODUCIBILITY AND PHYSIOLOGICAL LEFT-VENTRICULAR FILLING PATTERNS

Qualitatively, dobutamine stress echocardiography has become an establ ished procedure. Quantitative results are in great demand but this is still difficult due to limited endo- and epicardial border definition. Transmitral Doppler variables are strictly quantitative and less subj ective. Furthermore, ischemic alterations precede systolic ones (ische mic cascade). There are preliminary reports of the utility of dobutami ne stress Doppler echocardiography, but proof of reproducibility and l eft ventricular filling patterns are still lacking. Fourteen healthy v olunteers (10 men, 4 women, median age 25.9 years, range 21-32 years) were investigated according to the usual dobutamine stress echocardiog raphic protocol (5, 10, 15, 20, 30, 40 and 40 mu g/kg/min+0.5 mg atrop ine). At each titration step a standardized transmitral PW-Doppler rec ording with the sample volume positioned at the opened mitral leafier tips was analyzed three times by two independent, experienced investig ators. Of the early, late, and mean velocities (V(max)E, V(max)A, V-me an), time integrals (VTI-E, VTI-A, VTI), their ratios (E/A, E/A VTI), and various time intervals (T-acc, T-dec, E- and A-duration, FillT), V (max)E (0.82 to 1.09 m/s; P<0.0001), VTI-E (16.17 to 17.19 cm; P<0.000 1) and V-mean (0.29 to 0.82 m/s; P<0.0001) were found to have the grea test discriminatory power, commencing already at a dose of 10-15 mu g/ kg/min dobutamine. V(max)E and VTI-E demonstrated the smallest intra- and interobserver variation without any increase in variability during incremental dose titration. Assessment of the early diastolic filling pattern by Doppler echocardiography is a valuable quantitative and re producible adjunct to conventional dobutamine stress echocardiography. Further controlled studies in coronary artery disease patients have t o confirm, whether lower dobutamine doses could be used in the test an d sensitivity increased due to better data acquisition in cases of lim ited echogenicity, less subjectivity, and earlier onset of ischemic al terations. Copyright (C) 1997 Elsevier Science Ireland Ltd.