Dobutamine Stress Echocardiography Doppler Estimation of Cardiac Diastolic Function: A Simultaneous Catheterization Correlation Study

Background: Doppler echocardiography using the ratio of early diastolic transmitral velocity to early diastolic mitral annular tissue velocity (E/E') is routinely used to evaluate left ventricular (LV) filling pressures at rest. We tested the hypothesis that measurement of E/E' in patients undergoing dobutamine stress echocardiography (DSE) will detect changes in LV filling pressures. Methods: In this prospective study, 16 patients with normal LV ejection fraction and normal coronary arteries by angiography underwent a standard DSE protocol with simultaneous LV filling pressure monitoring with a fluid filled pigtail catheter. Doppler echocardiographic assessment of LV diastolic function was performed using E/E' at rest and during DSE. Results: The average age of the study participants was 57 +/- 8 years. Average heart rate was 61 +/- 11 bpm at baseline and 141 +/- 12 bpm at peak stress. LV mean diastolic pressure decreased from 12.3 +/- 2.6 mmHg at baseline to 9.0 +/- 2.3 mmHg at peak stress (P = 0.0001). Baseline E/E' at the septum and lateral annulus were 8.7 +/- 2.2 and 7.5 +/- 1.9 and during peak stress were 8.3 +/- 3.1 and 7.9 +/- 3.5, respectively. There was no significant change in E/E' at either the septum or the lateral annulus (P = 0.55, P = 0.66). There was no significant correlation between LV mean diastolic pressure and E/E' with dobutamine stress. Conclusions: In patients with normal LV ejection fraction and no significant coronary artery disease undergoing DSE, the ratio of early diastolic transmitral velocity to early diastolic tissue velocity (E/E') at peak stress with dobutamine does not predict changes in LV filling pressures. (Echocardiography 2011;28:442-447).