Key result
Spontaneous or dobutamine-induced dynamic left ventricular obstruction was documented in 32% of patients with left ventricular ballooning syndrome and was associated with a higher prevalence of septal hypertrophy.
Why the study?
Does dobutamine stress echocardiography reveal dynamic intraventricular obstruction in patients with left ventricular ballooning syndrome?
Observational (n=22)
Does dobutamine stress echocardiography reveal dynamic intraventricular obstruction in patients with left ventricular ballooning syndrome?
Dobutamine stress echocardiography reveals that dynamic intraventricular obstruction occurs in about a third of patients with left ventricular ballooning syndrome and is strongly associated with septal hypertrophy.
Answers are grounded in this paper and cite their sources.
Dynamic obstruction screening via dobutamine echo warrants prospective study in left ventricular ballooning syndrome; leaves open its role in risk stratification or therapy.
BACKGROUND: Dynamic intraventricular obstruction has been observed in patients with left ventricular ballooning syndrome (LVBS) and has been hypothesized as a possible mechanism of the syndrome. The aim of this study was to assess the prevalence and significance of dynamic intraventricular obstruction in patients with LVBS. METHODS AND RESULTS: Dobutamine stress echocardiography was carried out in 22 patients with LVBS (82% apical), all women, aged 68 +/- 9 years. At baseline 1 patient had a > 30 mmHg LV gradient; during stress a LV gradient > 30 mm Hg developed in 6/21 patients (28%) and was caused by systolic anterior motion of the mitral valve in the 3 patients with severe gradient (mean 116 +/- 29 mmHg), who developed mitral regurgitation and impaired apical wall motion and by obstruction at mid-ventricular level in the other 3 with a moderate gradient (mean 46 +/- 16 mmHg). Compared with patients without obstruction those with obstruction had a greater mean septal thickness (11.6 +/- .6 vs 9.8. +/- 3, p < .01), a higher prevalence of septal hypertrophy (71% vs 7%, p < .005) and a higher peak wall motion score index (1.62 +/- .4 vs 1.08 +/- .4, p < .01). CONCLUSION: Spontaneous or dobutamine-induced dynamic LV obstruction is documented in 32% of patients with LVBS, is correlated with the presence of septal hypertrophy and may play a role in the development of LVBS in this subset of patients. In those without septal hypertrophy a dynamic obstruction is rarely induced with dobutamine and is unlikely to be a major pathogenetic factor of the syndrome.
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Previtali et al. (2010) conducted an observational in Left ventricular ballooning syndrome (LVBS) (n=22). Dynamic intraventricular obstruction vs. No dynamic intraventricular obstruction was evaluated on Prevalence of localized septal hypertrophy (p=<0.005). Spontaneous or dobutamine-induced dynamic left ventricular obstruction was documented in 32% of patients with left ventricular ballooning syndrome and was associated with a higher prevalence of septal hypertrophy.
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