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V L Roger

Publications and source records attributed to V L Roger.

At least 37 records · Page 2Linked to original sources
PubMed1999

Trends in heart disease deaths in Olmsted County, Minnesota, 1979-1994.

BACKGROUND: Although age-adjusted heart disease mortality has declined since the 1960s, this decline may not have applied equally to all subgroups. OBJECTIVE: To examine recent trends in heart disease mortality, specifically in women and in the elderly. METHODS: Age- and sex-specific heart disease mortality (International Classification of Diseases, Ninth Edition, Clinical Modification [ICD-9-CM] codes 390-398, 402, 404-429) in Olmsted County, Minnesota, between 1979 and 1994 were studied. RESULTS: The total number of heart disease deaths was 3095; 1578 (51%) occurred in women and 1984 (64%) in persons aged 75 years or older. Most heart disease deaths (77%) were coronary disease deaths (ICD-9-CM codes 410-414). Age-adjusted heart disease mortality rates declined from 123 per 100,000 (95% confidence interval [CI], 102-144/100,000) in 1979 to 81 per 100,000 (95% CI, 67-95/100,000) in 1994. Poisson regression analyses indicated that the trends differed according to sex and age. For women, the relative risk (RR) of heart disease death in 1994 compared with 1979 was 0.69 vs 0.53 for men (P = .06). This equates to a decline in heart disease mortality of 2.5% per year in women or 32% over the period and 4.2% per year in men or 47% over the period. The decline was less pronounced as age increased (P < .001). For 60-year-old women, the RR for 1994 compared with 1979 was 0.59, whereas for 80-year-old women, the RR for 1994 compared with 1979 was 0.76. For men, the RR for 1994 compared with 1979 was 0.60 for 80-year-old men vs 0.46 for 60-year-old men. CONCLUSIONS: Between 1979 and 1994, in Olmsted County, the decline in heart disease mortality was of lesser magnitude in women and in the elderly, emphasizing the importance of age- and sex-specific trends to characterize time patterns in heart disease deaths to target preventive measures.

Age Distribution↗
PubMed1998

Role of dobutamine stress echocardiography in predicting outcome in 860 patients with known or suspected coronary artery disease.

BACKGROUND: Increasingly, dobutamine stress echocardiography has been used for detection of coronary artery disease. Less information exists regarding the incremental prognostic value of the test, including semiquantitative wall scoring, compared with clinical and rest echocardiographic variables. METHODS AND RESULTS: Follow-up information was obtained from 860 patients who underwent dobutamine stress echocardiography over a 2-year period. To determine the value of dobutamine stress echocardiography in predicting cardiac events, including cardiac death and myocardial infarction, clinical and rest and stress echocardiographic data were considered in a stepwise Cox multivariate regression model. During follow-up of up to 52 months, 72 patients underwent coronary revascularization before any cardiac event and were censored. Eighty-six patients had cardiac events, including nonfatal myocardial infarction in 36 and cardiac death in 50. In a multivariate model, a history of congestive heart failure, the percentage of abnormal segments at peak stress, and an abnormal left ventricular end-systolic volume response to stress were independent predictors of cardiac events. The model that best predicted subsequent cardiac events included clinical and stress echocardiographic data. CONCLUSIONS: Dobutamine stress echocardiography with semiquantitative segmental wall scoring provides important incremental information in predicting subsequent cardiac events.

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PubMed1998

Dobutamine stress Doppler hemodynamics in patients with aortic stenosis: feasibility, safety, and surgical correlations.

OBJECTIVES: This study was designed to describe the experience of our center with the safety and feasibility of dobutamine stress echocardiography (DSE) in aortic stenosis (AS), to characterize the hemodynamic response to dobutamine infusion, and to examine the hemodynamic response in relation to the anatomic evaluation of the valve among patients who underwent valve replacement. BACKGROUND: The diagnosis of the hemodynamic severity of AS can be difficult when the cardiac output is reduced and the gradient is low, but the effective valve area calculates to be small. DSE has been proposed as a means of assessing the severity of AS in this setting. METHODS: We reviewed 27 patients (18 men, 9 women; mean age 71 +/- 12 years) with AS who underwent DSE between 1991 and 1996. RESULTS: Fifteen (55%) patients were New York Heart Association class III or IV, 8 (30%) had angina Canadian class III or IV, and 3 (11%) syncope. Dobutamine peak dose was 27 +/- 11 micrograms/kg/min. Sixteen (59%) patients had mild side effects. DSE resulted in a significant increase in the cardiac output from 4.1 +/- 1.2 L/min at rest to 7.3 +/- 1.9 L/min at peak dose, and in heart rate (76 +/- 16 beats/min to 124 +/- 20 beats/min), systolic blood pressure (128 +/- 26 mm Hg to 137 +/- 26 mm Hg), ejection fraction (38% +/- 20% to 42% +/- 20%), and transvalvular mean gradient (28 +/- 10 mm Hg to 39 +/- 9 mm Hg) (P <.05). There was also a significant increase in the valve area from 0.77 +/- 0.14 cm2 at rest to 0.97 +/- 0.21 cm2 (P <.001). Seven patients underwent surgery; all valves were severely calcified, confirming anatomic disease. In this group, an increase in the mean gradient but also a trend toward an increase in the valve area were noted in response to dobutamine: 33 +/- 10 mm Hg to 47 +/- 6 mm Hg and 0.79 +/- 0.11 cm2 to 0.95 +/- 0.19 cm2, respectively. CONCLUSION: Although more data are needed to fully establish the safety of the test in this indication, this study suggests that patients with AS can safely undergo DSE. Dobutamine results in an increase not only in the mean gradient, but also in the valve area. An increase in valve area with dobutamine was observed in some patients with anatomically confirmed severe AS and thus does not exclude fixed valve disease.

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PubMed1998

Outcome after normal exercise echocardiography and predictors of subsequent cardiac events: follow-up of 1,325 patients.

OBJECTIVES: This study sought to examine the outcome of a large group of patients after normal exercise echocardiography and to identify potential predictors of subsequent cardiac events. BACKGROUND: Earlier studies suggested that prognosis after normal exercise echocardiography is favorable, with a low subsequent cardiac event rate. These studies involved a small number of patients and did not have sufficient statistical power to stratify risk. METHODS: The outcomes of 1,325 patients who had normal exercise echocardiograms were examined. End points were overall and cardiac event-free survival. Cardiac events were defined as cardiac death, nonfatal myocardial infarction and coronary revascularization. Patient characteristics were analyzed in relation to time to first cardiac event in a univariate and multivariate manner to determine which, if any, were associated with an increased hazard of subsequent cardiac events. RESULTS: Overall survival of the study group was significantly better than that of an age- and gender-matched group obtained from life tables (p < 0.0001). The cardiac event-free survival rates at 1, 2 and 3 years were 99.2%, 97.8% and 97.4%, respectively. The cardiac event rate per person-year of follow-up was 0.9%. Subgroups with an intermediate or high pretest probability of having coronary artery disease also had low cardiac event rates. Multivariate predictors of subsequent cardiac events were angina during treadmill exercise testing (risk ratio [RR] 4.1, 95% confidence interval [CI] 1.5 to 11.0), low work load (defined as < 7 metabolic equivalents [METs] for men and < 5 METs for women; RR 3.2, 95% CI 1.4 to 7.6), echocardiographic left ventricular hypertrophy (RR 2.6, 95% CI 1.1 to 6.3) and advancing age (RR 1.04/year, 95% CI 1.0 to 1.1). CONCLUSIONS: The outcome after normal exercise echocardiography is excellent. Subgroups with an intermediate or high pretest probability of having coronary artery disease also have a favorable prognosis after a normal exercise echocardiogram. Characteristics predictive of subsequent cardiac events (i.e., patient age, work load, angina during exercise testing and echocardiographic left ventricular hypertrophy) should be considered in the clinical interpretation of a normal exercise echocardiogram.

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PubMed1998

Gender differences in use of stress testing and coronary heart disease mortality: a population-based study in Olmsted County, Minnesota.

OBJECTIVES: We sought to examine the utilization of exercise stress testing in relation to age and gender in a population-based setting. BACKGROUND: The utilization of noninvasive procedures has been shown to be associated with the subsequent use of invasive procedures. Yet, there are no population-based data on the utilization of stress testing; in particular, although gender differences in the use of invasive procedures have been reported, the use of noninvasive procedures has not been examined in relation to gender. METHODS: In Olmsted County, Minnesota, passive surveillance of the medical care of the community is provided through the Rochester Epidemiology Project. A population-based cohort of Olmsted County residents undergoing exercise tests was identified. The medical records of residents with prevalent and incident exercise tests in 1987 and 1988 were reviewed. For persons with an initial test (incidence cohort), data on clinical presentation, test indications and results were abstracted. Stress test utilization rates were calculated, and crude rates were directly adjusted to the age distribution of the 1980 U.S. population. To help interpret patterns of use at the population level, coronary heart disease mortality rates (International Classification of Diseases, 9th revision, codes 410 to 414) were calculated (crude and directly adjusted to the overall age distribution of the 1980 U.S. population) and used as an indicator of coronary disease burden. RESULTS: A total of 2,624 tests were performed. The crude utilization rate (per 100,000) was 1,888 for men and 703 for women (rate ratio for men over women 2.7, 95% confidence interval [CI] 2.5 to 2.9); it remained significantly higher in men across all age strata. The crude incidence rate (per 100,000) of initial stress tests was 1,112 for men and 517 for women (rate ratio 2.2, 95% CI 1.9 to 2.4). For both men and women, the incidence increased with age; however, incidence remained lower in women in all age strata. At the time that they underwent an initial test, women were more symptomatic and had poorer exercise performance than men. The rate ratio of men over women for coronary heart disease mortality was 1.1 (95% CI 0.9 to 1.2). The age-adjusted rate ratios for stress test utilization were 2.8 (95% CI 2.5 to 3.0), and that for coronary heart disease mortality was 1.9 (95% CI 1.7 to 2.2). CONCLUSIONS: These population-based data show that during the study period, the utilization of stress testing in Olmsted County was lower in women than in men. Women in the incidence cohort were older and more symptomatic and had poorer exercise performance than men. Such differences should be considered when examining the utilization of subsequent invasive procedures according to gender.

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PubMed1998

Exercise echocardiography: technique and diagnostic value.

Exercise echocardiography has experienced a rapid rise in clinical acceptance because of its recognized ability to detect coronary artery disease in addition to attractive features such as portability, versatility and relatively low cost. To achieve and maintain accuracy and diagnostic yield, adequate training of the sonographer and the cardiologist is essential.

Coronary Disease↗
PubMed1998

[Stress echography].

Although stress echocardiography was introduced in the beginning of the 1980s, it has only been widely used since the appearance of digital technology. This technique has undergone rapid development for the evaluation of coronary artery disease because of its diagnostic and prognostic contribution.

Coronary Disease↗
PubMed1997

Aortic valve replacement for aortic stenosis with severe left ventricular dysfunction. Prognostic indicators.

BACKGROUND: Aortic valve replacement for aortic stenosis (AS) carries an increased risk in the presence of left ventricular (LV) systolic dysfunction. Few data are available on the outcome of such patients. METHODS AND RESULTS: Between 1985 and 1992, 154 consecutive patients (107 men and 47 women) with LV systolic dysfunction (ejection fraction [EF] < or = 35%) underwent aortic valve replacement for AS. The mean preoperative characteristics included EF, 27 +/- 6%; aortic valve mean gradient, 44 +/- 18 mm Hg; aortic valve area, 0.6 +/- 0.2 cm2; and cardiac output, 4.1 +/- 1.5 L/min. Simultaneous coronary artery bypass graft surgery was performed in 78 patients (51%). Perioperative (30-day) mortality was 9% (14 of 154 patients). Fifty patients died during follow-up. Coronary artery disease (P = .002) and a reduced preoperative cardiac output (P = .03) were significantly related to reduced overall survival rate by multivariate analysis. Postoperative improvement occurred in most patients; 88% were New York Heart Association class III or IV before surgery versus 7% after surgery. Postoperative EF was assessed in 76% of survivors; 76% of these demonstrated improvement. By multivariate analysis, change in EF was inversely related to coronary disease (P = .002) and preoperative aortic valve area (P = .03). CONCLUSIONS: Despite LV dysfunction, the risk of aortic valve replacement for AS was acceptable and related to coronary artery disease and mean aortic gradient, and long-term survival was related to coronary disease and cardiac output. Improvement in symptoms and EF occurred in most patients.

Adult↗
PubMed1997

Sex and test verification bias. Impact on the diagnostic value of exercise echocardiography.

BACKGROUND: The use of exercise echocardiography for the diagnosis of coronary artery disease (CAD) has been validated in pilot studies but is not documented in clinical practice and in women comparatively with men. The objectives of this study were to determine the effects of sex and of test verification bias on the diagnostic performance of exercise echocardiography. METHODS AND RESULTS: Three thousand six hundred seventy-nine consecutive patients (1714 women, 1965 men) who underwent an exercise echocardiographic study were studied; the observed sensitivity, specificity, and correct classification rate were calculated among 340 patients (244 men, 96 women) who underwent angiography; to study the effect of test verification bias, sensitivity and specificity were estimated for all patients who underwent exercise echocardiography including those not referred to angiography. In the angiographic group, the prevalence of CAD was 60% in women and 80% in men. The observed sensitivity and specificity of exercise echocardiography was 78% and 44% in men and 79% and 37% in women. After adjustment for test verification bias, the estimated sensitivity was lower in women (32% versus 42% in men), whereas specificity was similar in both sexes. The positive predictive value was lower in women (66%) compared with men (84%). CONCLUSIONS: In clinical practice, test verification bias results in a lower observed specificity and a higher sensitivity of exercise echocardiography. In women, positive predictive value and adjusted sensitivity are lower compared with that in men.

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PubMed1997

Aortic valve resistance in aortic stenosis: Doppler echocardiographic study and surgical correlation.

Four hundred seven patients with aortic stenosis who had Doppler echocardiography before surgery were studied to determine the feasibility of Doppler-derived valve resistance calculation and its clinical value. Patients with milder aortic stenosis had lower mean gradient, larger valve area, and lower maximal resistance than those with severe stenosis. Maximal resistance was related strongly to aortic stenosis severity but did not add any information after valve area and gradient were known and was not related to surgical mortality.

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PubMed1997

Paradoxical sinus deceleration during dobutamine stress echocardiography: description and angiographic correlation.

OBJECTIVES: This report characterizes the paradoxical sinus deceleration occasionally observed during dobutamine stress testing and determines its relation to myocardial ischemia. BACKGROUND: Dobutamine stress echocardiography is widely accepted as a noninvasive tool for evaluating coronary artery disease. With infusion of dobutamine, there is typically a dose-dependent increase in heart rate. However, in some patients, a paradoxical decrease in heart rate has been observed during high dose dobutamine infusion. METHODS: In 181 consecutive patients undergoing both dobutamine stress echocardiography and coronary angiography, electrocardiographic (ECG) data collected during dobutamine infusion were reviewed to identify patients with a decrease in heart rate. The clinical, stress echocardiographic, hemodynamic and angiographic correlates of patients with a decrease in heart rate were reviewed. RESULTS: A decrease in heart rate ranging from 7 to 64 beats/min occurred during high dose dobutamine infusion in 14 patients (8%, 95% confidence interval [CI] 6% to 10%), including 3 in whom a junctional rhythm developed. The decrease was sudden in five patients (36%, 95% CI 13% to 65%) and gradual in nine (64%, 95% CI 35% to 87%). A decrease in blood pressure (12 patients [86%], 95% CI 57% to 98%) with simultaneous chest pain (7 patients [50%], 95% CI 23% to 77%) and nausea (5 patients [36%], 95% CI 13% to 65%) was common. Significant coronary artery disease (> or = 50% diameter stenosis) was present in 8 (57%) of 14 patients (95% CI 29% to 82%). Two patients (14%, 95% CI 2% to 43%) had no clinical, ECG or echocardiographic evidence of ischemia and no significant coronary artery disease by angiography. There was no increased incidence of right coronary artery stenosis in patients with paradoxical sinus deceleration. CONCLUSIONS: Paradoxical sinus deceleration occurs in 8% of patients during dobutamine stress testing. Although most often observed in patients with coronary artery disease, it can occur in the absence of ischemia and coronary artery disease, and in some patients may be due to a vasodepressor reflex.

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PubMed1997

Is review of videotape necessary after review of digitized cine-loop images in stress echocardiography? A prospective study in 306 patients.

The interpretation of stress echocardiography has been made easier by the comparison of digitized prestress and poststress frame-grabbed images (cine-loops), each representing a portion of a single cardiac cycle. Often, review of these digitized images is substituted for review of the complete videotape record of the examination. An alternative is to review both the digitized images as well as the videotape record of the rest and stress images. To date, there has been insufficient documentation of whether these options (cine-loop images alone versus cine-loop images plus videotape) provide comparable or additive information. Therefore, we prospectively evaluated information obtained from review of cine-loop images versus combined review of cine-loop images and videotape records in 306 consecutive patients undergoing treadmill (213 patients, 70%) or dobutamine (93 patients, 30%) stress echocardiography. An experienced echocardiologist first reviewed the cine-loop images and scored the wall motion in 16 segments at rest and with stress. Next, the complete videotape record was reviewed with repeated wall motion scoring. A questionnaire comparing cine-loop and videotape images was completed at the end of each review. Digitization of images was technically inadequate in 14 patients (4%). In 116 (40%) of the other 292 patients, the regional wall motion assessment, after relying solely on cine-loop images, was modified with subsequent videotape review. In 40 patients (14%), these modifications resulted in a change in the final impression regarding whether the study result was normal or abnormal. In a multivariate analysis, age, gender, and type of stress echocardiography had no significant influence on discordance of the cine-loop image and combined cine-loop and video information. Stepwise logistic regression analysis identified poorer image quality (p < 0.0001) and regional wall motion abnormalities (p < 0.0001) as predictors of discordance between cine-loop and combined review. We conclude that relying solely on digitized cine-loop images representing a single cardiac cycle is not optimal, especially if the quality of the digitized images is suboptimal and if regional wall motion abnormalities are present. Thus we recommend a combined review of both cine-loop images and videotape images in the interpretation of stress echocardiography.

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PubMed1996

Safety of performing dobutamine stress echocardiography in patients with abdominal aortic aneurysm > or = 4 cm in diameter.

Dobutamine stress echocardiography is frequently used for preoperative assessment of cardiac risk before major vascular surgical procedures. Dobutamine increases myocardial contractility, heart rate, and rate of increase of left ventricular pressure and has a variable effect on blood pressure. These effects could potentially increase the likelihood of rupture of a vascular aneurysm. The safety of performing dobutamine stress echocardiography in patients with vascular aneurysms has not been adequately addressed. Of 1,968 consecutive patients who underwent dobutamine stress echocardiography at our institution, 98 patients with abdominal aortic aneurysms > or = 4 cm in diameter were identified. Records were reviewed to determine whether there was any evidence of aneurysm rupture or adverse vascular events as a result of the stress test. There was no case of aneurysm rupture or hemodynamic instability precipitated by dobutamine stress echocardiography. In addition, dobutamine stress echocardiography that was negative for ischemia identified patients at very low risk of perioperative cardiac events. The positive predictive value of ischemia during dobutamine echocardiography was 29%. Dobutamine stress echocardiography may be performed safely in patients with aortic aneurysms. Precipitation of an aneurysmal complication, including rupture, by the test is unlikely. In addition, preoperative dobutamine stress echocardiography can identify patients at very low risk of perioperative cardiac events.

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PubMed1996

Comparison of ischemic response during exercise and dobutamine echocardiography in patients with left main coronary artery disease.

OBJECTIVES: This study sought to compare manifestations of myocardial ischemia evoked by exercise and dobutamine echocardiography in patients with left main coronary artery disease. BACKGROUND: During exercise testing, left ventricular cavity dilation, marked ST segment depression and blood pressure decrease indicate severe coronary artery disease. Whether these signs are comparably evoked by dobutamine echocardiography has not been described. METHODS: Fifty-four patients who underwent stress echocardiography (36 exercise, 18 dobutamine) and coronary angiography showing > or = 50% left main stenosis were analyzed. Electrocardiographic and blood pressure changes, symptoms, wall motion score indexes and sensitivity for coronary artery disease were compared. In 47 patients, the left ventricular endocardium was traced to quantify volumes and ejection fraction. RESULTS: Stress-induced regional wall motion abnormalities developed in 91% of patients; this was not different on exercise (89%) or dobutamine echocardiography (94%). Rate-pressure product and wall motion score index, similar at rest, tended to be higher after exercise than after dobutamine stress (p = 0.07 and p = 0.05, respectively). ST segment depression > or = 1 mm was more common with exercise (p = 0.005). Ejection fraction and end-systolic and end-diastolic volume indexes were comparable at rest in both groups. With exercise, ejection fraction decreased in 87% of patients, and end-systolic and end-diastolic volume indexes increased in 80%. In contrast, with dobutamine, decreased ejection fraction and increased volume indexes were infrequent. Ejection fraction was lower ([mean +/- SD] 45 +/- 19% vs. 54 +/- 12%, p = 0.007) and end-diastolic (69 +/- 26 vs. 50 +/- 17 ml/m2, p =0.02) and end-systolic (39 +/- 20 vs. 24 +/- 13 ml/m2, p = 0.02) volume indexes were higher after exercise than after dobutamine stress. CONCLUSIONS: On the basis of changes in regional wall motion both dobutamine and exercise echocardiography have a comparable high sensitivity in diagnosing myocardial ischemia in left main coronary artery disease. However, conventional signs of severe myocardial ischemia, including left ventricular cavity dilation and marked ST segment depression, occur more often with exercise than with dobutamine echocardiography.

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PubMed1996

Atropine augmentation in dobutamine stress echocardiography: role and incremental value in a clinical practice setting.

OBJECTIVES: This study sought to evaluate the role and incremental value of atropine in a large patient group undergoing dobutamine stress echocardiography. BACKGROUND: The use of atropine to potentiate dobutamine stress is not standard practice. Although the utility of atropine has been described, data on its incremental value remain limited and do not exist for a routine clinical practice setting. METHODS: Dobutamine stress echocardiography was performed in 1,171 patients with use of a standard protocol. Atropine (maximal dose 2.0 mg) was given to 299 patients (26%) who did not attain target heart rate. Coronary angiography was performed in 183 patients (46 received atropine), 148 of whom were found to have significant coronary artery disease (> or = 70% diameter stenosis in a major epicardial vessel, > or = 50% stenosis for left main coronary artery disease). All tests were reviewed independently by experienced observers. RESULTS: There were no major adverse events. Patients receiving atropine had a lower rest heart rate (65 vs. 74 beats/min, p < 0.0001) and more often received beta-adrenergic blocking agents (49% vs. 14%, p < 0.0001). Of 444 patients in whom stress-induced ischemia developed, 70 (16%) required atropine before ischemia became evident. Sensitivity for detection of significant coronary artery disease was 90% with dobutamine alone and 95% after the addition of atropine. In 66 patients with normal wall motion at rest, test sensitivity was 65% before and 84% after atropine was given. Atropine use did not compromise test specificity. New diagnostic information was obtained in 20 (50%) of 40 patients with angiographic coronary artery disease given atropine. Proportionately more patients with single-vessel disease required atropine before an ischemic response was observed; this effect appeared related to the higher ischemic threshold in these patients. CONCLUSIONS: Augmentation of heart rate had a modest influence on the overall diagnostic sensitivity of dobutamine stress echocardiography in our study cohort. However, it was particularly helpful in patients receiving beta-blockers and those with milder coronary disease. Despite the use of > or = 1 mg of atropine in some patients, this incremental value was not achieved at the expense of safety.

Adult↗
PubMed1996

Effect of Doppler echocardiography on utilization of hemodynamic cardiac catheterization in the preoperative evaluation of aortic stenosis.

OBJECTIVE: To examine the use of Doppler echocardiography in preoperative assessment of aortic stenosis and to determine its effect on subsequent use of hemodynamic cardiac catheterization. MATERIAL AND METHODS: We retrospectively reviewed a consecutive series of 574 adult patients who underwent aortic valve replacement for aortic stenosis between 1990 and 1992 at our institution. The use of Doppler echocardiography and cardiac catheterization and the predictive factors for use of hemodynamic catheterization were analyzed. RESULTS: After Doppler echocardiography in 423 patients, invasive hemodynamic assessment of the severity of aortic stenosis was performed in only 42% (179 patients). The use of cardiac catheterization declined over time (54% in 1990, 40% in 1991, and 35% in 1992) (P = 0.003), whereas no significant change in the baseline clinical characteristics of the population or in severity of stenosis as determined by Doppler echocardiography occurred during that time. Multivariate analysis identified the following variables as independent predictors of use of cardiac catheterization after Doppler echocardiography: clinically not severe aortic stenosis, mean gradient of less than 50 mm Hg determined by Doppler echocardiography, Doppler-determined aortic valve area of more than 0.8 cm2 or not calculated, attending cardiologist not specialized in echocardiography, and earlier year of assessment. CONCLUSION: After Doppler echocardiography, less than 50% of our patients undergoing aortic valve replacement for aortic stenosis have cardiac catheterization preoperatively. The use of cardiac catheterization after Doppler echocardiography--thus, duplication of hemodynamic assessment--declined significantly over time during the study period. Decline in the use of catheterization is related to the degree of diagnostic certainty provided by Doppler echocardiography and to the level of familiarity of the attending cardiologist with the technique.

Adult↗
PubMed1995

Normal stroke volume and cardiac output response during dobutamine stress echocardiography in subjects without left ventricular wall motion abnormalities.

Dobutamine stress echocardiography has become widely utilized for evaluation of coronary artery disease, but the expected responses of stroke volume and cardiac output to the high doses of dobutamine administered in these studies are not known. To determine these responses, stroke volume and cardiac output were measured with 2-dimensional Doppler echocardiography at each stage of dobutamine stress echocardiography and after administration of atropine in 47 patients without resting or inducible wall motion abnormalities. Heart rate increased significantly at each stage of dobutamine infusion and after atropine. Mean blood pressure decreased at the 5 micrograms/kg/min dose, then showed little change. Stroke volume increased 27 +/- 18% from baseline, with significant increases occurring at both the 5 and 10 micrograms/kg/min doses (p < 0.00001). With higher doses of dobutamine, stroke volume tended to plateau or decrease. Mean changes in stroke volume were not significant between the doses of 10, 20, and 30 micrograms/kg/min. The mean change in stroke volume from the 30 to the 40 micrograms/kg/min dose was a significant decrease of 6.3% (p = 0.004); the decrease from the 40 micrograms/kg/min dose to atropine approached statistical significance (p = 0.06). Cardiac output increased throughout dobutamine infusion. Stroke volume during dobutamine stress echocardiography is commonly maximum at a dose of 20 micrograms/kg/min and tends to decline at higher infusion rates. At higher doses, increases in cardiac output are mediated primarily by increases in heart rate.

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