Circulation. 2002;106:809-813
Published online before print July 29, 2002, doi: 10.1161/01.CIR.0000025611.21140.34
Published online before print July 29, 2002, doi: 10.1161/01.CIR.0000025611.21140.34
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(Circulation. 2002;106:809.)
© 2002 American Heart Association, Inc.
Clinical Investigation and Reports |
Low-Output, Low-Gradient Aortic Stenosis in Patients With Depressed Left Ventricular Systolic Function
The Clinical Utility of the Dobutamine Challenge in the Catheterization Laboratory
From the Division of Cardiovascular Diseases and Internal Medicine (R.A.N., J.A.G., H.M.C., S.T.H., D.R.H.) and the Division of Cardiovascular Surgery (H.V.S.), Mayo Clinic, Rochester, Minn.
Reprint requests to Rick A. Nishimura, MD, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Background— Although aortic valve replacement can be performed at an acceptable risk level in selected patients with left ventricular systolic dysfunction and low-output, low-gradient aortic stenosis, not all patients presenting with these hemodynamics will benefit from the operation. Some patients may have only mild aortic stenosis, despite a small calculated valve area. We report on the clinical utility of diagnostic dobutamine stimulation during cardiac catheterization in these diagnostically challenging patients.
Methods and Results— Thirty-two patients with low-output, low-gradient aortic stenosis and an ejection fraction <40% had dobutamine infusion in the catheterization laboratory. On the basis of the results of the dobutamine test, 21 patients underwent aortic valve replacement. All patients with a final aortic valve area 
1.2 cm2 at peak dobutamine infusion and a mean gradient of >30 mm Hg were found to have severe calcific aortic stenosis at operation. In the 15 patients in whom contractile reserve was identified during dobutamine challenge (increase in stroke volume >20%), 1 patient died perioperatively (7% mortality) and 12 patients were alive in New York Heart Association class I or II status at follow-up.
Conclusions— In patients with left ventricular systolic dysfunction and aortic stenosis with a low output and a low mean gradient, dobutamine challenge may aid in selecting those who would benefit from an aortic valve operation.
Key Words: valves • cardiomyopathy • hemodynamics • inotropic agents • surgery
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