Utility of dobutamine stress echocardiography in aortic valve
regurgitation and reduced left ventricular function
Abstract
Objective: Predictors for post-operative reverse remodeling in patients
with severe aortic regurgitation (AR) and reduced left ventricular
ejection fraction (LVEF) are unknown. We performed low-dose dobutamine
stress echocardiography (DSE) in patients with severe AR and reduced
LVEF to evaluate the relationship between contractile reserve (CR) and
reverse remodeling after surgery. Methods: In 31 patients with chronic
severe AR and reduced LVEF (LVEF < 50%), we performed
pre-operative DSE, assessed CR and examined whether changes in
preoperative DSE were associated with improvement of post-operative LVEF
after aortic valve surgery. Results: The pre-operative echocardiographic
findings were as follows: left ventricular (LV) end-diastolic dimension:
67 ± 10 mm, LV end-systolic dimension: 52 ± 13 mm and LVEF: 42% ± 8%.
All patients underwent aortic valve surgery. Patients with pre-operative
LVEF of >45% exhibited a significant increase in LVEF;
however, patients with pre-operative LVEF of <45% showed no
significant change. When we examined the results of DSE performed in
patients with pre-operative LVEF of <45%, ΔLVEF of ≥6% (with
CR) during DSE was related to an improvement in post-operative LVEF;
ΔLVEF of ≥6% during DSE predicted an improvement in post-operative
LVEF, with a sensitivity and specificity of 80% and 85%, respectively.
Conclusions: DSE may be a helpful tool for predicting post-operative
reverse remodeling in patients with severe AR and moderately reduced
LVEF.