Low-output, low-gradient aortic stenosis in patients with depressed left ventricular systolic function: The clinical utility of the dobutamine challenge in the catheterization laboratory

• Published in: Circulation (New York, N.Y.) N.Y.), 2002-08, Vol.106 (7), p.809-813
• Main Authors: NISHIMURA, Rick A, GRANTHAM, J. Aaron, CONNOLLY, Heidi M, SCHAFF, Hartzell V, HIGANO, Stuart T, HOLMES, David R
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Agonists; Aged; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - surgery; Biological and medical sciences; Cardiac Catheterization; Cardiotonic Agents; Cardiovascular system; Dobutamine; Dose-Response Relationship, Drug; Female; Hemodynamics - drug effects; Humans; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Patient Selection; Predictive Value of Tests; Prospective Studies; Stroke Volume - drug effects; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - diagnosis
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.0000025611.21140.34

Although aortic valve replacement can be performed at an acceptable risk level in selected patients with left ventricular systolic dysfunction and low-output, low-gradient aortic stenosis, not all patients presenting with these hemodynamics will benefit from the operation. Some patients may have only mild aortic stenosis, despite a small calculated valve area. We report on the clinical utility of diagnostic dobutamine stimulation during cardiac catheterization in these diagnostically challenging patients. Thirty-two patients with low-output, low-gradient aortic stenosis and an ejection fraction 30 mm Hg were found to have severe calcific aortic stenosis at operation. In the 15 patients in whom contractile reserve was identified during dobutamine challenge (increase in stroke volume >20%), 1 patient died perioperatively (7% mortality) and 12 patients were alive in New York Heart Association class I or II status at follow-up. In patients with left ventricular systolic dysfunction and aortic stenosis with a low output and a low mean gradient, dobutamine challenge may aid in selecting those who would benefit from an aortic valve operation.