Dobutamine stress echocardiography in pulmonary arterial hypertension

Stefano Ghio, Federico Fortuni, Alessandra Greco, Annalisa Turco, Carlo Lombardi, Laura Scelsi, Claudia Raineri, Benedetta Matrone, Eleonora Vullo, Stefania Guida, Roberto Badagliacca, Luigi Oltrona Visconti

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: There is a growing interest in exploring the concept of right ventricular functional reserve in patients with pulmonary arterial hypertension. However, it is still unclear how it should be assessed. Aim of the study was to investigate the determinants of the changes in cardiac output and in pulmonary pressure during dobutamine stress echocardiography in pulmonary arterial hypertension. Methods: Low-dose dobutamine stress echocardiography was performed in 55 patients and 28 controls. Tricuspid annular plane systolic excursion, its ratio to systolic pulmonary artery pressure, right ventricular area change, degree of tricuspid regurgitation, right ventricular end-systolic pressure-area ratio, cardiac output were assessed at rest and at peak stress. Results: According to the stress induced increase in cardiac output, patients were classified into 2 groups: above/equal to the median of 2.8 L/min (high cardiac output) or below the median (low cardiac output). High cardiac output patients were characterized by a greater increase in heart rate (+45.1 ± 17.5 vs +21.3 ± 17.7 bpm), a greater improvement in tricuspid annular plane systolic excursion (+4.2 ± 3.3 vs +1.9 ± 2.6 mm, P = 0.005) and a decrease in tricuspid regurgitation (P = 0.010) as compared to low cardiac output patients. Changes in pulmonary pressure were not associated with changes in indicators of right ventricular function but only with changes in heart rate. Conclusions: The increase in cardiac output during dobutamine is associated with an improvement in longitudinal right ventricular function, a decrease in tricuspid regurgitation and an increase in heart rate. Changes in pulmonary pressure only reflect the changes in heart rate.

Original languageEnglish
Pages (from-to)331-335
JournalInternational Journal of Cardiology
Volume270
DOIs
Publication statusPublished - 2018
Externally publishedYes

Fingerprint

Stress Echocardiography
Pulmonary Hypertension
Tricuspid Valve Insufficiency
Cardiac Output
Heart Rate
High Cardiac Output
Low Cardiac Output
Right Ventricular Function
Pressure
Lung
Dobutamine
Ventricular Pressure
Pulmonary Artery
Blood Pressure

Keywords

  • Contractility reserve
  • Pulmonary arterial hypertension
  • Right ventricle

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Dobutamine stress echocardiography in pulmonary arterial hypertension. / Ghio, Stefano; Fortuni, Federico; Greco, Alessandra; Turco, Annalisa; Lombardi, Carlo; Scelsi, Laura; Raineri, Claudia; Matrone, Benedetta; Vullo, Eleonora; Guida, Stefania; Badagliacca, Roberto; Oltrona Visconti, Luigi.

In: International Journal of Cardiology, Vol. 270, 2018, p. 331-335.

Research output: Contribution to journalArticle

Ghio, Stefano ; Fortuni, Federico ; Greco, Alessandra ; Turco, Annalisa ; Lombardi, Carlo ; Scelsi, Laura ; Raineri, Claudia ; Matrone, Benedetta ; Vullo, Eleonora ; Guida, Stefania ; Badagliacca, Roberto ; Oltrona Visconti, Luigi. / Dobutamine stress echocardiography in pulmonary arterial hypertension. In: International Journal of Cardiology. 2018 ; Vol. 270. pp. 331-335.
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AU - Fortuni, Federico

AU - Greco, Alessandra

AU - Turco, Annalisa

AU - Lombardi, Carlo

AU - Scelsi, Laura

AU - Raineri, Claudia

AU - Matrone, Benedetta

AU - Vullo, Eleonora

AU - Guida, Stefania

AU - Badagliacca, Roberto

AU - Oltrona Visconti, Luigi

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N2 - Background: There is a growing interest in exploring the concept of right ventricular functional reserve in patients with pulmonary arterial hypertension. However, it is still unclear how it should be assessed. Aim of the study was to investigate the determinants of the changes in cardiac output and in pulmonary pressure during dobutamine stress echocardiography in pulmonary arterial hypertension. Methods: Low-dose dobutamine stress echocardiography was performed in 55 patients and 28 controls. Tricuspid annular plane systolic excursion, its ratio to systolic pulmonary artery pressure, right ventricular area change, degree of tricuspid regurgitation, right ventricular end-systolic pressure-area ratio, cardiac output were assessed at rest and at peak stress. Results: According to the stress induced increase in cardiac output, patients were classified into 2 groups: above/equal to the median of 2.8 L/min (high cardiac output) or below the median (low cardiac output). High cardiac output patients were characterized by a greater increase in heart rate (+45.1 ± 17.5 vs +21.3 ± 17.7 bpm), a greater improvement in tricuspid annular plane systolic excursion (+4.2 ± 3.3 vs +1.9 ± 2.6 mm, P = 0.005) and a decrease in tricuspid regurgitation (P = 0.010) as compared to low cardiac output patients. Changes in pulmonary pressure were not associated with changes in indicators of right ventricular function but only with changes in heart rate. Conclusions: The increase in cardiac output during dobutamine is associated with an improvement in longitudinal right ventricular function, a decrease in tricuspid regurgitation and an increase in heart rate. Changes in pulmonary pressure only reflect the changes in heart rate.

AB - Background: There is a growing interest in exploring the concept of right ventricular functional reserve in patients with pulmonary arterial hypertension. However, it is still unclear how it should be assessed. Aim of the study was to investigate the determinants of the changes in cardiac output and in pulmonary pressure during dobutamine stress echocardiography in pulmonary arterial hypertension. Methods: Low-dose dobutamine stress echocardiography was performed in 55 patients and 28 controls. Tricuspid annular plane systolic excursion, its ratio to systolic pulmonary artery pressure, right ventricular area change, degree of tricuspid regurgitation, right ventricular end-systolic pressure-area ratio, cardiac output were assessed at rest and at peak stress. Results: According to the stress induced increase in cardiac output, patients were classified into 2 groups: above/equal to the median of 2.8 L/min (high cardiac output) or below the median (low cardiac output). High cardiac output patients were characterized by a greater increase in heart rate (+45.1 ± 17.5 vs +21.3 ± 17.7 bpm), a greater improvement in tricuspid annular plane systolic excursion (+4.2 ± 3.3 vs +1.9 ± 2.6 mm, P = 0.005) and a decrease in tricuspid regurgitation (P = 0.010) as compared to low cardiac output patients. Changes in pulmonary pressure were not associated with changes in indicators of right ventricular function but only with changes in heart rate. Conclusions: The increase in cardiac output during dobutamine is associated with an improvement in longitudinal right ventricular function, a decrease in tricuspid regurgitation and an increase in heart rate. Changes in pulmonary pressure only reflect the changes in heart rate.

KW - Contractility reserve

KW - Pulmonary arterial hypertension

KW - Right ventricle

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