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Heart 2001;86:397-404; doi:10.1136/heart.86.4.397
Copyright © 2001 BMJ Publishing Group Ltd & British Cardiovascular Society
Heart 2001;86:397-404 ( October )

Cardiovascular medicine

Long axis electromechanics during dobutamine stress in patients with coronary artery disease and left ventricular dysfunction A M Duncan, C A O'Sullivan, G S Carr-White, D G Gibson, M Y Henein

Department of Echocardiography, The Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK

Correspondence to: Dr Henein m.henein{at}rbh.nthames.nhs.uk

Accepted 20 June 2001

OBJECTIVE---To dissociate the effect of inotropy from activation change during dobutamine stress on left ventricular long axis function in patients with coronary artery disease (CAD).
METHODS---25 patients with CAD and normal left ventricular cavity size and 30 with cavity dilatation---18 with normal activation (DCM-NA) and 12 with left bundle branch block (DCM-LBBB)---were compared with 20 controls. 12 lead ECG and septal long axis echograms were assessed at rest and peak dobutamine stress. Amplitude, shortening and lengthening velocities, postejection shortening, Q wave to onset of shortening (Q-OS), and A2 to onset of lengthening (A2-OL) were measured. Inotropy was evaluated from peak aortic acceleration.
RESULTS---In controls, amplitude, shortening and lengthening velocities, and peak aortic acceleration increased with stress; QRS, Q-OS, and A2-OL shortened (all p < 0.001); and contraction remained coordinate. In the group of patients with CAD and normal left ventricular cavity size, shortening velocity and peak aortic acceleration increased with stress (p < 0.005). However, amplitude and lengthening velocity did not change, QRS, Q-OS, and A2-OL lengthened (p < 0.01), and incoordination appeared. Results were similar in the group with DCM-NA. In the DCM-LBBB group, shortening velocity and peak aortic acceleration increased modestly with stress (p < 0.01) but amplitude, lengthening velocity, QRS, Q-OS, A2-OL, and incoordination remained unchanged. Overall, change in shortening velocity correlated with that in peak aortic acceleration (r2 = 0.71), in amplitude with that in lengthening velocity (r2 = 0.74), and in QRS with both Q-OS (r2 = 0.69) and A2-OL (r2 = 0.63).
CONCLUSION---The normal long axis response to dobutamine reflects both inotropy and rapid activation. In CAD, inotropy is preserved with development of ischaemia but the normal increase in amplitude is lost and prolonged activation delays the time course of shortening, causing pronounced incoordination. Overall, shortening rate uniformly reflects inotropy while lengthening rate depends mainly on systolic amplitude rather than primary diastolic involvement, even with overt ischaemia.


Keywords: stress echocardiography; activation; inotropy; incoordination

© 2001 by Heart
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