Key result
Contractile reserve (ΔLVEF ≥6%) during dobutamine stress echocardiography predicted post-operative LVEF improvement with 80% sensitivity and 85% specificity in severe aortic regurgitation.
Why the study?
Predictors for post-operative reverse remodeling in patients with severe aortic regurgitation and reduced LVEF are unknown.
Does pre-operative low-dose dobutamine stress echocardiography predict improvement in post-operative LVEF in patients with severe aortic regurgitation and reduced LVEF?
Observational (n=31)
Does pre-operative low-dose dobutamine stress echocardiography predict improvement in post-operative LVEF in patients with severe aortic regurgitation and reduced LVEF?
Effect estimate: Sensitivity 80%, Specificity 85%
Low-dose dobutamine stress echocardiography can help predict post-operative reverse remodeling in patients with severe aortic regurgitation and moderately reduced LVEF.
May support surgical timing decisions in severe AR with reduced LVEF; hypothesis-generating and requires prospective validation before changing practice.
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.
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Saito et al. (2021) conducted an observational in chronic severe aortic regurgitation and reduced LVEF (n=31). Contractile reserve during low-dose dobutamine stress echocardiography vs. No contractile reserve was evaluated on improvement in post-operative LVEF (Sensitivity 80%, Specificity 85%). Contractile reserve (ΔLVEF ≥6%) during dobutamine stress echocardiography predicted post-operative LVEF improvement with 80% sensitivity and 85% specificity in severe aortic regurgitation.
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