PMID- 14713180
OWN - NLM
STAT- MEDLINE
DCOM- 20040423
LR  - 20191210
IS  - 0001-5385 (Print)
IS  - 0001-5385 (Linking)
VI  - 58
IP  - 6
DP  - 2003 Dec
TI  - Left atrial function as a predictor of haemodynamic response in patients with 
      mitral stenosis: a dobutamine stress echocardiographic study.
PG  - 539-45
AB  - OBJECTIVE: The mechanisms of the different haemodynamic and clinical responses to 
      dobutamine infusion in mitral stenosis (MS) are not clearly established. The aim 
      of this study was to evaluate the relation between left atrial (LA) function and 
      haemodynamic response in patients with MS during dobutamine infusion. METHODS AND 
      RESULTS: Forty-two consecutive moderately symptomatic patients (33 women, 9 men; 
      mean age 46+/-9, range from 26 to 66), New York Heart Association (NYHA) class II 
      with MS (mean mitral valve area 1.7+/-0.1 cm2) were evaluated with dobutamine 
      stress echocardiography. Haemodynamic measurements were obtained at rest and 
      during peak dobutamine infusion. LA fractional shortening at rest was used as an 
      index of global LA function. Group I consisting of patients with significantly 
      elevated pulmonary artery pressure (> 60 mm Hg) and mean transmitral gradient (> 
      15 mm Hg) at peak dobutamine infusion were defined as haemodynamically serious 
      MS. Group II consisted of the remaining 30 patients whose haemodynamic data were 
      below these levels. While baseline haemodynamic parameters and mitral valve 
      characteristics were not different between the two groups, LA fractional 
      shortening was significantly lower (18.9+/-2.8 vs. 32.3+/-5.1%, p<0.0001) and 
      left atrial dimension was significantly larger in group I (49.7+/-2.3 mm vs 
      43.6+/-5.3 mm, p<0.0001). Left atrial fractional shortening was negatively 
      correlated with the increase in mean transmitral gradient (r:-0.58, p<0.01). When 
      the patients were divided using a LA fractional shortening level of 25% as the 
      cut-off point, we observed that the patients with low LA fractional shortening 
      had a greater increase in mean transmitral gradient (7.3+/-3.1 mm Hg vs. 
      4.6+/-1.4 mm Hg), p = 0.005) and pulmonary artery pressure (22.4+/-3.5 mm Hg vs. 
      16.1+/-8.5 mm Hg, p = 0.001) compared to the patients with high LA fractional 
      shortening. Based on these haemodynamic results, management was changed in 12 
      patients (28%): 5 underwent percutaneous mitral balloon commissurotomy and 7 
      received intensive medical treatment. CONCLUSIONS: The present study demonstrates 
      that haemodynamic response during dobutamine stress echocardiography correlates 
      with LA fractional shortening in patients with MS. The evaluation of left atrial 
      function at rest in patients with ambiguous symptoms and mild mitral stenosis may 
      be useful in clinical decision making. Atrial dysfunction at rest may predict the 
      haemodynamic response during stress echo in these patients.
FAU - Belgi, Aytul
AU  - Belgi A
AD  - Akdeniz University Department of Cardiology, Antalya, Turkey. aybel68@hotmail.com
FAU - Yalcinkaya, Selim
AU  - Yalcinkaya S
FAU - Cetin, Seyhan
AU  - Cetin S
FAU - Kabukcu, Mehmet
AU  - Kabukcu M
FAU - Golbasi, Ilhan
AU  - Golbasi I
FAU - Sancaktar, Oktay
AU  - Sancaktar O
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
PL  - England
TA  - Acta Cardiol
JT  - Acta cardiologica
JID - 0370570
RN  - 0 (Adrenergic beta-Agonists)
RN  - 3S12J47372 (Dobutamine)
SB  - IM
MH  - Adrenergic beta-Agonists/administration & dosage
MH  - Adult
MH  - Aged
MH  - Atrial Function, Left/*physiology
MH  - Dobutamine/administration & dosage
MH  - Echocardiography, Stress
MH  - Female
MH  - Heart Atria/diagnostic imaging/physiopathology
MH  - Heart Rate/drug effects/physiology
MH  - Hemodynamics/*physiology
MH  - Humans
MH  - Infusions, Intravenous
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/diagnostic imaging/*physiopathology
MH  - Mitral Valve Stenosis/diagnostic imaging/*physiopathology
MH  - Predictive Value of Tests
MH  - Pulmonary Wedge Pressure/drug effects/physiology
MH  - Severity of Illness Index
MH  - Statistics as Topic
MH  - Systole/drug effects/physiology
EDAT- 2004/01/10 05:00
MHDA- 2004/04/24 05:00
CRDT- 2004/01/10 05:00
PHST- 2004/01/10 05:00 [pubmed]
PHST- 2004/04/24 05:00 [medline]
PHST- 2004/01/10 05:00 [entrez]
AID - 10.2143/AC.58.6.2005319 [doi]
PST - ppublish
SO  - Acta Cardiol. 2003 Dec;58(6):539-45. doi: 10.2143/AC.58.6.2005319.