Electromechanical interrelations during dobutamine stress in normal subjects and patients with coronary artery disease: comparison of changes in activation and inotropic state

Objective-To identify the effects of altered ventricular activation during dobutamine stress on left ventricular function in normal subjects and in pa tients with coronary artery disease, and to distinguish these from an inotr opic response. Design-Prospective analysis of 12 lead ECG and echocardiogram at rest and a t peak stress. Setting-Tertiary referral centre for cardiac disease equipped with non-inva sive facilities for pharmacological stress testing. Methods-22 patients with coronary artery disease were compared with 17 age matched controls. Left ventricular ejection and filling patterns were asses sed using Doppler echocardiography. Activation effects were correlated with relative left ventricular ejection and filling times, and the Z ratio ([le ft ventricular ejection + filling times]/RR interval). Inotropic response w as measured from peak aortic acceleration. Results-In controls, QRS shortened (by 4 ms, p < 0.001), and total ejection and filling periods lengthened (by 2 s/min, p < 0.01 and 5 s/min, p < 0.00 1, respectively). The Z ratio thus increased and correlated with QRS shorte ning (r(2) = 0.69). Peak aortic acceleration (PAA) increased by 135%, p < 0 .001. In patients, QRS lengthened at peak stress (by 9 ms, p < 0.001). Tota l ejection and filling times did not change, but Z ratio fell, correlating with QRS prolongation (r(2) = 0.65). Nevertheless, PAA increased by 63%, p < 0.001. Conclusions-Relative ejection and filling times reflect ventricular activat ion at rest and during stress independent of changes in inotropic state. By contrast, peak aortic acceleration reflects the positive inotropic effect of dobutamine on the myocardium, regardless of changes in activation.