OBJECTIVES: The aim of this study was to determine the prognostic value of assessing left atrial function during dobutamine stress testing. BACKGROUND: Left ventricular diastolic dysfunction precedes systolic wall motion abnormalities in the ischemic cascade. Severity of left ventricular diastolic function during cardiac stress is not characterized well by current clinical imaging protocols but may be an important prognostic factor. We hypothesized that abnormal early left atrial emptying measured during dobutamine stress cardiac magnetic resonance will reflect these diastolic changes and may be associated with cardiovascular outcomes. METHODS: We enrolled 122 consecutive patients referred for dobutamine stress cardiac magnetic resonance for suspected myocardial ischemia. Left atrial volumes were retrospectively measured by the biplane area-length method at left ventricular end-systole (VOL(max)) and before atrial contraction (VOL(bac)). Left atrial passive emptying fraction defined by (VOL(max) - VOL(bac)) × 100%/VOL(max) and the absolute percent increase in left atrial passive emptying fraction during dobutamine stress (ΔLAPEF) were quantified. RESULTS: Twenty-nine major adverse cardiac events (MACE) occurred during follow-up (median 23 months). By Kaplan-Meier analysis, patients with ΔLAPEF <10.8 (median) experienced higher incidence of MACE than did patients with a ΔLAPEF >10.8 (p = 0.004). By univariable analysis, ΔLAPEF was strongly associated with MACE (unadjusted hazard ratio for every 10% decrease = 1.56, p < 0.005). By multivariable analysis, every 10% decrease in ΔLAPEF carried a 57% increase in MACE, after adjustment to presence of myocardial ischemia and infarction. CONCLUSIONS: Reduced augmentation of left atrial passive emptying fraction during dobutamine stress demonstrated strong association with MACE. We speculate that reduced left atrial passive emptying reserve during inotropic stress may represent underlying diastolic dysfunction and warrants further investigation.
OBJECTIVES: The aim of this study was to determine the prognostic value of assessing left atrial function during dobutamine stress testing. BACKGROUND:Left ventricular diastolic dysfunction precedes systolic wall motion abnormalities in the ischemic cascade. Severity of left ventricular diastolic function during cardiac stress is not characterized well by current clinical imaging protocols but may be an important prognostic factor. We hypothesized that abnormal early left atrial emptying measured during dobutamine stress cardiac magnetic resonance will reflect these diastolic changes and may be associated with cardiovascular outcomes. METHODS: We enrolled 122 consecutive patients referred for dobutamine stress cardiac magnetic resonance for suspected myocardial ischemia. Left atrial volumes were retrospectively measured by the biplane area-length method at left ventricular end-systole (VOL(max)) and before atrial contraction (VOL(bac)). Left atrial passive emptying fraction defined by (VOL(max) - VOL(bac)) × 100%/VOL(max) and the absolute percent increase in left atrial passive emptying fraction during dobutamine stress (ΔLAPEF) were quantified. RESULTS: Twenty-nine major adverse cardiac events (MACE) occurred during follow-up (median 23 months). By Kaplan-Meier analysis, patients with ΔLAPEF <10.8 (median) experienced higher incidence of MACE than did patients with a ΔLAPEF >10.8 (p = 0.004). By univariable analysis, ΔLAPEF was strongly associated with MACE (unadjusted hazard ratio for every 10% decrease = 1.56, p < 0.005). By multivariable analysis, every 10% decrease in ΔLAPEF carried a 57% increase in MACE, after adjustment to presence of myocardial ischemia and infarction. CONCLUSIONS: Reduced augmentation of left atrial passive emptying fraction during dobutamine stress demonstrated strong association with MACE. We speculate that reduced left atrial passive emptying reserve during inotropic stress may represent underlying diastolic dysfunction and warrants further investigation.
Authors: O P Simonetti; R J Kim; D S Fieno; H B Hillenbrand; E Wu; J M Bundy; J P Finn; R M Judd Journal: Radiology Date: 2001-01 Impact factor: 11.105
Authors: R J Kim; D S Fieno; T B Parrish; K Harris; E L Chen; O Simonetti; J Bundy; J P Finn; F J Klocke; R M Judd Journal: Circulation Date: 1999-11-09 Impact factor: 29.690
Authors: Allison M Pritchett; Steven J Jacobsen; Douglas W Mahoney; Richard J Rodeheffer; Kent R Bailey; Margaret M Redfield Journal: J Am Coll Cardiol Date: 2003-03-19 Impact factor: 24.094
Authors: Sachin Gupta; Susan A Matulevicius; Colby R Ayers; Jarett D Berry; Parag C Patel; David W Markham; Benjamin D Levine; Kelly M Chin; James A de Lemos; Ronald M Peshock; Mark H Drazner Journal: Eur Heart J Date: 2012-07-10 Impact factor: 29.983
Authors: John A Dodson; Tomas G Neilan; Ravi V Shah; Hoshang Farhad; Ron Blankstein; Michael Steigner; Gregory F Michaud; Roy John; Siddique A Abbasi; Michael Jerosch-Herold; Raymond Y Kwong Journal: Circ Cardiovasc Imaging Date: 2014-06-05 Impact factor: 7.792
Authors: Tomas G Neilan; Jessie P Bakker; Bhavneesh Sharma; Robert L Owens; Hoshang Farhad; Ravi V Shah; Siddique A Abbasi; Puja Kohli; Joel Wilson; Anthony DeMaria; Michael Jerosch-Herold; Raymond Y Kwong; Atul Malhotra Journal: Can J Cardiol Date: 2014-08-19 Impact factor: 5.223
Authors: Tomas G Neilan; Otavio R Coelho-Filho; Ravi V Shah; Jiazuo H Feng; Diego Pena-Herrera; Damien Mandry; Francois Pierre-Mongeon; Bobak Heydari; Sanjeev A Francis; Javid Moslehi; Raymond Y Kwong; Michael Jerosch-Herold Journal: Am J Cardiol Date: 2012-12-08 Impact factor: 2.778
Authors: Ajay D Rao; Ravi V Shah; Rajesh Garg; Siddique A Abbasi; Tomas G Neilan; Todd S Perlstein; Marcelo F Di Carli; Michael Jerosch-Herold; Raymond Y Kwong; Gail K Adler Journal: Am J Cardiol Date: 2013-04-15 Impact factor: 2.778
Authors: Tomas G Neilan; Otavio R Coelho-Filho; Ravi V Shah; Siddique A Abbasi; Bobak Heydari; Eri Watanabe; Yucheng Chen; Damien Mandry; Francois Pierre-Mongeon; Ron Blankstein; Raymond Y Kwong; Michael Jerosch-Herold Journal: JACC Cardiovasc Imaging Date: 2013-05-01
Authors: Henrique Doria de Vasconcellos; Theingi Tiffany Win; Ela Chamera; Seo Young Hong; Bharath Ambale Venkatesh; Patrick Young; Xiaoying Yang; Luisa Ciuffo; Ravi K Sharma; Masamichi Imai; Mohammadali Habibi; Colin O Wud; Susan R Heckbert; David A Bluemke; Joao A C Lima Journal: Acad Radiol Date: 2020-04-09 Impact factor: 3.173
Authors: Yuko Y Inoue; Abdullah Alissa; Irfan M Khurram; Kotaro Fukumoto; Mohammadali Habibi; Bharath A Venkatesh; Stefan L Zimmerman; Saman Nazarian; Ronald D Berger; Hugh Calkins; Joao A Lima; Hiroshi Ashikaga Journal: J Am Heart Assoc Date: 2015-04-27 Impact factor: 5.501