The clinical significance of the incorporation of tissue Doppler imaging into low-dose Dobutamine stress echocardiograph
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(2020) 20:416
CASE REPORT
Open Access
The clinical significance of the incorporation of tissue Doppler imaging into low-dose Dobutamine stress echocardiography in patients with aortic stenosis prior to Transcatheter aortic valve implantation Sahrai Saeed1*† , Joerg Kellermair2†, Jon Herstad1 and Øyvind Bleie1
Abstract Background: Low-dose dobutamine stress echocardiography (DSE) is indicated in patients with low flow (stroke volume index [SVi] < 35 ml/m2) low gradient (mean pressure gradient < 40 mmHg) and left ventricular ejection fraction (LVEF) < 50% aortic stenosis (AS) to assess LV contractile reserve (> 20% increase in SVi) and severity grade of AS. Severe AS is defined by a mean pressure gradient of 40 mmHg occurring at any time during the test when aortic valve area remains < 1.0 cm2. Case presentation: This case report highlights the utility of mitral annular systolic velocity (S′) by tissue Doppler imaging and peak LV outflow tract (LVOT) velocity as markers of LV intrinsic contractile function during DSE in a patient with low flow low gradient AS and reduced EF prior to transcatheter aortic valve implantation (TAVI). Conclusions: Mitral annular S′ and peak LVOT velocities are reliable markers of LV intrinsic contractile function and should be incorporated into routine low-dose DSE. Keywords: Aortic stenosis, Dobutamine-stress-echocardiography, Tissue Doppler, Mitral annular systolic velocity, Intrinsic contractile function
Background This case is of clinical interest for physicians and sonographers who perform DSE in patient with classical low flow low gradient AS to assess contractile reserve, the patterns of flow normalization and the hemodynamic severity of AS. However, the incorporation of mitral * Correspondence: [email protected] † Sahrai Saeed and Joerg Kellermair contributed equally to this work. 1 Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway Full list of author information is available at the end of the article
annular S′ and peak LVOT velocity into low dose DSE may provide additional information on the LV intrinsic contractile function and the potentials for recovery of LV function following valve intervention.
Case presentation A 82-year-old male with known coronary artery disease (previous coronary artery bypass grafting following myocardial infarction), diabetes type II, hypertension and hypercholesterolemia, and smoking-induced chronic obstructive pulmonary disease (FEV1 69%) was referred to
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