JIAO Yuqing 1 , ZHANG Haibo 1 , LUO Tiange 1 , ZHANG Chun 2 , HAN Jie 3 , ZHAO Yichen 1 , WANG Jiangang 1
  • 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;
WANG Jiangang, Email: jiangangwang@ccmu.edu.cn
Dobutamine; stress echocardiography; valvular heart disease; surgery
10.7507/1007-4848.202504034
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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 encompasses data from patients undergoing 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). 61 (61.6%) 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 was in 40 patients (40.4%). 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 LVEFin the positive group were better than those before operation, and had significant differences with the negative group (P<0.05). All seven patients with negative DSE results underwent interventional surgery, which was significant different with the positive group (36 patients, 41.9%). In the limited dose group (n=6), four patients underwent routine thoracotomy surgery with positive DSE results or showing improvement, 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.

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