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Original Research: Pulmonary Vascular Disease |

Dobutamine Stress Echocardiography for the Assessment of Pressure-Flow Relationships of the Pulmonary CirculationNoninvasive Assessment of Pulmonary Circulation

Edmund M. T. Lau, MD, FCCP; Rebecca R. Vanderpool, PhD; Preeti Choudhary, MD; Lisa R. Simmons, PhD; Tamera J. Corte, PhD; Paola Argiento, MD; Michele D’Alto, MD; Robert Naeije, PhD; David S. Celermajer, PhD
Author and Funding Information

From the Discipline of Medicine (Drs Lau, Choudhary, Corte, and Celermajer), Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Respiratory Medicine (Drs Lau and Corte), Department of Cardiology (Drs Lau, Choudhary, Simmons, and Celermajer), Royal Prince Alfred Hospital, Sydney, NSW, Australia; Department of Cardiology (Drs Argiento and D’Alto), Second University of Naples, Naples, Italy; and Department of Pathophysiology (Drs Vanderpool and Naeije), Free University of Brussels, Brussels, Belgium.

CORRESPONDENCE TO: Edmund M. T. Lau, MD, FCCP, Department of Respiratory Medicine, Royal Prince Alfred Hospital, Missendon Rd, Camperdown, NSW 2050, Australia; e-mail: edmundmtlau@gmail.com


FOR EDITORIAL COMMENT SEE PAGE 876

FUNDING/SUPPORT: This study was supported by the National Health and Medical Research Council (NHMRC) of Australia Project [Grant 1022141 to Dr Celermajer and Dr Corte] and a NHMRC and Heart Foundation Postgraduate Scholarship to Dr Lau [No. 633136].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;146(4):959-966. doi:10.1378/chest.13-2300
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BACKGROUND:  Stress testing of the pulmonary circulation (via increasing pulmonary blood flow) can reveal abnormal mean pulmonary artery pressure-cardiac output (mPpa-Q) responses, which may facilitate early diagnosis of pulmonary vascular disease. We investigated the application of dobutamine stress echocardiography (DSE) for the noninvasive assessment of mPpa-Q relationships.

METHODS:  DSE using an incremental dose protocol (≤ 20 μg/kg/min) was performed in 38 subjects (16 patients with pulmonary arterial hypertension [PAH] and 22 healthy control subjects). An additional 22 healthy control subjects underwent exercise stress echocardiography as a comparator group. Multipoint mPpa-Q plots were analyzed, and the pulmonary vascular distensibility coefficient α was calculated.

RESULTS:  DSE was feasible and informative in 93% of subjects. The average dobutamine-induced mPpa-Q slope was 1.1 ± 0.7 mm Hg/L/min in healthy control subjects and 5.1 ± 2.5 mm Hg/L/min in patients with PAH (P < .001). The dobutamine-induced α was markedly reduced in patients with PAH (0.003 ± 0.001 mm Hg vs 0.02 ± 0.01 mm Hg in control subjects, P < .001). When exercise and dobutamine stress were compared in healthy control subjects, the exercise-induced mPpa-Q slope was modestly higher (1.6 ± 0.7 mm Hg/L/min, P = .03 vs dobutamine). In patients with PAH, lower functional class status was associated with lower dobutamine-induced mPpa-Q slopes (P = .014), but not with resting total pulmonary vascular resistance.

CONCLUSIONS:  Noninvasive assessment of mPpa-Q relationships is feasible with dobutamine stress. DSE may potentially be a useful noninvasive technique for stress testing of the pulmonary vasculature.

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