Akademik Veri Yönetim Sistemi
Turk Kardiyoloji Dernegi Arsivi, cilt.30, sa.4, ss.233, 2002 (Scopus)
Background: The mechanisms of the different hemodynamic and clinical responses to dobutamine infusion in mitral stenosis are not clearly established. The aim of this study was to evaluate the changing hemodynamic parameters in patiens with mitral stenosis that correlates with dyspnea during dobutamine infusion using Doppler echocardiography and to assess determinants of pulmonary artery pressure response. Methods and Results: Fifty-seven consecutive asymptomatic or mildly symptomatic patient (51 women, 6 men; mean age 43±7, range from 26 to 52), New York Heart Association (NYHA) class I (n: 9), class II (n: 48) with mitral stenosis (mean mitral valve area 1.6±0.4 cm2) were evaluated with dobutamine stress echocardiography. Dyspnea developed during dobutamine infusion in 18 patients (Group B), but the other 39 patients remained asymptomatic (group A). There was a significantly greater increment in mitral peak gradient (14±7 vs 9±4 mmHg, p=0.008), mean gradient (12±6 vs 6±3 mmHg, p<0.0001), and pulmonary artery systolic pressure (23±8 vs 16±6 mmHg, p=0.007) during dobutamine infusion in the patients who developed dyspnea than in those who did not. Furthermore the hemodynamic response to dobutamine identified a subgroup of patients with more serious mitral stenosis. Based on these clinical and hemodynamic results, management was changed in 12 patients (21%): 7 underwent percutaneous mitral balloon commissurotomy, 4 underwent mitral valve replacement, and 1 received intensive medical treatment. In all patients, pulmonary artery systolic pressure (p<0.0001), mean mitral gradient (p=0.001) at rest, mitral valve area (p=0.003) and subvalvular mitral score (p=0.001) which is the sign of the mitral valve damage were significantly correlated with pulmonary artery pressure response. Conclusion: In conclusion, our results suggest that patients who have provoked dyspnea during the dobutamine infusion have a greater increase in hemodynamic parameters than patients who do not. Pulmonary artery pressure response correlates with baseline pulmonary artery pressure, mean gradient, mitral valve area and subvalvular echo score and pulmonary artery pressure response can be predicted by these parameters.