Dobutamine stress-induced ischemic right ventricular dysfunction in patients with three-vessel coronary artery disease
Keywords:
Right ventricular dysfunction, Coronary artery disease, Dobutamine, Stress echocardiographyAbstract
Background: Dobutamine stress echocardiography (DSE) is a non-invasive technique to detect coronary artery diseases (CAD). There are limited studies on evaluation of the right ventricular function by stress echocardiography. The appropriate evaluation of RV function and early diagnosis of its failure can help to improve outcomes for the patients undergoing cardiac surgery. Objective: To determine right ventricular dysfunction in patients with three-vessel CAD by using DSE. Methods: This cross-sectional study was among 13 patients who were candidates for coronary artery bypass grafting (CABG) referred to Ghaem Hospital, Mashhad, Iran; from September 2015 to May 2016. After a physical examination and initial measures, DSE was performed and echocardiographic parameters were recorded by a cardiologist. Paired-samples t-test was performed using SPSS Software v.16.0 for data analysis. Results: The study included 13 patients (9 males) with a mean age of 65.4±7.6 years. The mean of TAPS was 16.9±4.5 mm and 15.7±2.9 mm before and after stress echocardiography, respectively (p=0.69). Systolic right ventricular (SRV) peak increased from before DSE compared with after DSE (8.0±2.2 vs. 13.7±4.2 mm/s, p<0.001). In addition, after dobutamine injection, right ventricular (RV) cardiac output decreased in 7 patients and one patient was affected by post-ejection shortening. Conclusion: It seems that TAPS and RV cardiac output after injection of dobutamine, can be used as markers for the recognition of ischemic RV dysfunction.References
Ebrahimi M, Kazemi-Bajestani SM, Ghayour-Mobarhan M, Ferns GA. Coronary artery disease and its risk
factors status in iran: a review. Iran Red Crescent Med J. 2011; 13(9): 610-23. PMID: 24069531, PMCID:
PMC3779358.
Perk J, De Backer G, Gohlke H, Graham I, Reiner Ž, Verschuren M, et al. European Guidelines on
cardiovascular disease prevention in clinical practice (version 2012) The Fifth Joint Task Force of the
European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical
Practice (constituted by representatives of nine societies and by invited experts)Developed with the special
contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).
European Heart Journal. 2012; 33(13): 1635-701. doi: 10.1093/eurheartj/ehs092.
Wijns W, Kolh P, Danchin N, Di Mario C, Falk V, Folliguet T, et al. Guidelines on myocardial
revascularization. Eur Heart J. 2010; 31(20): 2501-55. doi: 10.1093/eurheartj/ehq277. PMID: 20802248.
Jeremias A, Kaul S, Rosengart TK, Gruberg L, Brown DL. The impact of revascularization on mortality in
patients with nonacute coronary artery disease. Am J Med. 2009; 122(2): 152-61. doi:
1016/j.amjmed.2008.07.027. PMID: 19185092.
Dharampal AS, Papadopoulou SL, Rossi A, Meijboom WB, Weustink A, Dijkshoorn M, et al. Diagnostic
performance of computed tomography coronary angiography to detect and exclude left main and/or three- vessel coronary artery disease. Eur Radiol. 2013; 23(11): 2934-43. doi: 10.1007/s00330-013-2935-6.
PMID: 23812241.
Picano E, Pellikka PA. Stress echo applications beyond coronary artery disease. Eur Heart J. 2014; 35(16):
-40. doi: 10.1093/eurheartj/eht350. PMID: 24126880.
Elsherbiny IA. The significance of E/E′ to detect coronary artery disease during dobutamine stress
echocardiography. The Egyptian Heart Journal. 2012; 64(1): 21-6. doi: 10.1016/j.ehj.2011.09.003.
Chenzbraun A. Non-ischaemic cardiac conditions: role of stress echocardiography. Echo Res Pract. 2014;
(1): R1-7. doi: 10.1530/erp-14-0030. PMID: 26693299, PMCID: PMC4676472.
O'Sullivan CA, Duncan A, Daly C, Li W, Oldershaw P, Henein MY. Dobutamine stress-induced ischemic
right ventricular dysfunction and its relation to cardiac output in patients with three-vessel coronary artery
disease with angina-like symptoms. Am J Cardiol. 2005; 96(5): 622-7. doi: 10.1016/j.amjcard.2005.04.031.
PMID: 16125482.
Yang HS, Mookadam F, Warsame TA, Khandheria BK, Tajik JA, Chandrasekaran K. Evaluation of right
ventricular global and regional function during stress echocardiography using novel velocity vector
imaging. Eur J Echocardiogr. 2010; 11(2): 157-64. doi: 10.1093/ejechocard/jep190. PMID: 19946117.
Yuan Z, He C, Yan S, Huang D, Wang H, Tang W. Acupuncture for overactive bladder in female adult: a
randomized controlled trial. World J Urol. 2015; 33(9): 1303-8. doi: 10.1007/s00345-014-1440-0. PMID:
Cook C, Cole G, Asaria P, Jabbour R, Francis DP. The annual global economic burden of heart failure.
International Journal of Cardiology. 2014; 171(3): 368-76. doi: 10.1016/j.ijcard.2013.12.028.
Hedman A, Alam M, Zuber E, Nordlander R, Samad BA. Decreased right ventricular function after
coronary artery bypass grafting and its relation to exercise capacity: a tricuspid annular motion-based study.
J Am Soc Echocardiogr. 2004; 17(2): 126-31. doi: 10.1016/j.echo.2003.10.023. PMID: 14752486.
Stein KL, Breisblatt W, Wolfe C, Gasior T, Hardesty R. Depression and recovery of right ventricular
function after cardiopulmonary bypass. Crit Care Med. 1990; 18(11): 1197-200. PMID: 2225885.
Haber I, Metaxas DN, Geva T, Axel L. Three-dimensional systolic kinematics of the right ventricle. Am J
Physiol Heart Circ Physiol. 2005; 289(5): H1826-33. doi: 10.1152/ajpheart.00442.2005. PMID: 15964922.
Armstrong DW, Matangi MF. Estimated right ventricular systolic pressure during exercise stress
echocardiography in patients with suspected coronary artery disease. Can J Cardiol. 2010; 26(2): e45-9.
PMID: 20151058, PMCID: PMC2851391.
Wranne B, Pinto FJ, Hammarstrom E, St Goar FG, Puryear J, Popp RL. Abnormal right heart filling after
cardiac surgery: time course and mechanisms. Br Heart J. 1991; 66(6): 435-42. PMID: 1772709, PMCID:
PMC1024818.
Polak JF, Holman BL, Wynne J, Colucci WS. Right ventricular ejection fraction: an indicator of increased
mortality in patients with congestive heart failure associated with coronary artery disease. J Am Coll
Cardiol. 1983; 2(2): 217-24. PMID: 6306086.
Mertes H, Sawada SG, Ryan T, Segar DS, Kovacs R, Foltz J, et al. Symptoms, adverse effects, and
complications associated with dobutamine stress echocardiography. Experience in 1118 patients.
Circulation. 1993; 88(1): 15-9. doi: 10.1161/01.cir.88.1.15.
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