Assessment of myocardial reserve using dobutamine stress echocardiography in valvular heart diseases with reduced ejection fraction and its implications for surgical strategy
- VernacularTitle:多巴酚丁胺负荷超声对射血分数减低瓣膜性心脏病心肌储备的评估及在手术策略中的价值
- Author:
Yuqing JIAO
1
;
Haibo ZHANG
1
;
Tiange LUO
1
;
Chun ZHANG
2
;
Jie HAN
3
;
Yichen ZHAO
1
;
Jiangang WANG
1
Author Information
1. Center for Valve and Atrial Fibrillation Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 101100, P. R. China
2. Department of Interventional Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China
3. Center for Heart Failure and Valve Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, P. R. China
- Publication Type:Journal Article
- Keywords:
Dobutamine;
stress echocardiography;
valvular heart disease;
surgery
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2026;33(08):1258-1266
- CountryChina
- Language:Chinese
-
Abstract:
Objective To elucidate the application scope and delineate the criteria of dobutamine stress echocardiography (DSE) in assessing surgical risk associated with valvular heart diseases in patients presenting with reduced left ventricular ejection fraction (LVEF). Methods This retrospective analysis encompassed data from patients with reduced LVEF (LVEF<40%) who underwent DSE prior to valvular heart surgery at the Valvular Surgery Center of Beijing Anzhen Hospital between May 2016 and September 2024. Patients were stratified based on the terminal dose of dobutamine into two cohorts: a limited dose group [receiving a maximum dobutamine dose of <5 µg/(kg·min) due to concomitant conditions such as suspected atrial thrombus, aortic dilation, or previous myocardial infarction] and a non-limited dose group (where dosage was adjusted to either achieve the maximum positive standard or the maximal dose tolerable by the patient). Within the non-limited dose group, patients were further classified into positive and negative response groups. The positive response post DSE was defined based on the following criteria: LVEF≥55% (the maximum positive standard), LVEF<55% but with a 5% improvement (the minimum positive standard) from resting situation, aortic maximum velocity (AVmax)≥400 cm/s, or mean pressure gradient (meanPG)≥40 mm Hg, latter two applicable only to patients with aortic stenosis. Clinical indicators were compared in the three groups. Results A total of 99 patients were enrolled, aged 35 to 87 years, with an average age of (61.7±10.1) years. The number of males was significantly higher than that of females (3:1). There were 61 (61.6%) patients undergoing aortic valve surgery, 25 (25.3%) undergoing mitral valve surgery, and 13 (13.1%) undergoing combined aortic and mitral valve surgery. Nineteen (19.2%) patients experienced adverse symptoms such as palpitations, head and face numbness, dizziness, chest tightness post DSE. Additionally, new-onset or aggravated ventricular premature ventricular contractions were in 40 (40.4%) patients. All above symptoms and signs resolved minutes after cessation of the test. No severe adverse events necessitating oxygen therapy or emergency intervention occurred. Among the 93 patients in the non-limited dose group, 86 were classified in the positive response group and 7 in the negative response group. The left ventricular end diastolic diameter, left ventricular end systolic diameter, and LVEF in the positive group all showed significant improvement compared to preoperative values, and were also significantly better than those in the negative group (P<0.05). All 7 patients with negative DSE results underwent interventional surgery, which was significantly different from the positive group (36 patients, 41.9%). In the limited dose group (n=6), 4 patients with a positive result or a positive trend on DSE underwent median sternotomy, 2 received interventional treatment due to a negative response. No significant differences in mortality were observed among the groups (P>0.05). Conclusion Dobutamine stress echocardiography significantly contributes to risk stratification in surgical interventions for patients with valvular heart disease complicated by reduced LVEF. It aids in determining optimal timing and methods for surgery. With comprehensive patient evaluation and controlled dobutamine dosing, the application of DSE can be safely expanded.
