Clinical trial NCT00774891: Comparison Of Left Ventricular Volume And Wall Stress With Dobutamine And Exercise Echocardiography
Official title: Comparison Of Left Ventricular Volume And Wall Stress With Dobutamine And Exercise Echocardiography
Study type: OBSERVATIONAL
Overall status: WITHDRAWN
Conditions: Ischemia
Angina
Keywords: Echocardiography- exercise
Echocardiography- dobutamine
Wall stress
Ventricular volume-left
Ischemia
Angina
Heart diseases
Stress echocardiography
Ventricular volume
Vascular diseases
Lead sponsor: Lahey Clinic
Sponsor class: OTHER
First posted: 2008-10-17
Enrollment: 0
Sex: ALL
Minimum age (years): 30
Maximum age (years): 80
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: COHORT
Time perspective: PROSPECTIVE
Sampling method: NON_PROBABILITY_SAMPLE
Study population: Lahey Clinic patients referred by their physician for stress echocardiograms for clinical indications. Approximately 30 patients referred for an exercise stress echocardiography and approximately 30 patients referred for a dobutamine stress echocardiography.

Brief summary: This study will compare the physiologic responses between exercise stress echocardiography and pharmacologic stress echocardiography on left ventricular volume and wall stress.

Detailed description: This prospective observational study will compare the physiologic responses between exercise stress echocardiography and dobutamine stress echocardiography on left ventricular volume and wall stress. Exercise and dobutamine stress testing are two widely employed diagnostic modalities that are often used, interchangeably, to detect inducible ischemia. We hypothesize that dobutamine leads to significantly lower ventricular volumes and wall stress than exercise.

Some previous studies have shown that dobutamine and exercise echocardiography have comparable sensitivities and specificities, differences exist between the hemodynamic effects produced by each modality on the cardiovascular system. These variable effects may lead to differences in left ventricular size, volume and wall stress. If divergent left ventricular effects exist(between exercise and dobutamine induced stress), then the degree of myocardial oxygen consumption, ischemic burden, and ischemic threshold observed during exercise and dobutamine stress testing may be different between these commonly used modalities of stress testing.

The potentially variable effects on the left ventricle in response to the modality used to induce stress would highlight a physiological difference between exercise and dobutamine stress testing. Differences in volumes and stress could also help explain the greater of ischemia and higher frequency of angina and ST-segment deviation which has been previously observed in some studies during exercise as compared to dobutamine echocardiography. The presence or lack of these expected hemodynamic responses may also have additional diagnostic and prognostic implications.

The study involves the collection of data among patients undergoing stress echocardiograms that are clinically indicated. This data will be retrieved from the echocardiogram and report and medical chart, including baseline clinical characteristics, exercise parameters achieved during the test.

Eligibility criteria: Inclusion Criteria:

* Age 30-80 years
* Normal sinus rhythm on electrocardiogram
* Normal left ventricular systolic function on baseline echocardiogram

Exclusion Criteria:

* Patients with stress-induced wall motion abnormalities
* Left ventricular hypertrophy
* Evidence of prior myocardial infarction
* More than mild valvular heart disease
* Prior cardiac surgery
* Poor technical quality of echocardiogram

Primary outcomes:
measure: Dobutamine stress echocardiography causes decrease in LV size/volume and wall stress compared to exercise stress echocardiography
timeFrame: 1 hour
Secondary outcomes:
Other outcomes:
Locations:
city: Burlington
country: United States
facility: Lahey Clinic, Inc.
state: Massachusetts
Study officials:
affiliation: Lahey Clinic, Inc.
name: Sherif B. Labib, M.D.
role: PRINCIPAL_INVESTIGATOR
References:
citation: Iwasaka T, Nakamura S, Sugiura T, Tarumi N, Yuasa F, Morita Y, Wakayama Y, Inada M. Difference between women and men in left ventricular pump function during predischarge exercise test after acute myocardial infarction. Am J Cardiol. 1994 Jan 1;73(1):11-5. doi: 10.1016/0002-9149(94)90719-6.
citation: Mertes H, Erbel R, Nixdorff U, Mohr-Kahaly S, Kruger S, Meyer J. Exercise echocardiography for the evaluation of patients after nonsurgical coronary artery revascularization. J Am Coll Cardiol. 1993 Apr;21(5):1087-93. doi: 10.1016/0735-1097(93)90229-t.
citation: Perez JE, Waggoner AD, Davila-Roman VG, Cardona H, Miller JG. On-line quantification of ventricular function during dobutamine stress echocardiography. Eur Heart J. 1992 Dec;13(12):1669-76. doi: 10.1093/oxfordjournals.eurheartj.a060123.
citation: Rallidis L, Cokkinos P, Tousoulis D, Nihoyannopoulos P. Comparison of dobutamine and treadmill exercise echocardiography in inducing ischemia in patients with coronary artery disease. J Am Coll Cardiol. 1997 Dec;30(7):1660-8. doi: 10.1016/s0735-1097(97)00376-8.
citation: Dagianti A, Penco M, Agati L, Sciomer S, Dagianti A, Rosanio S, Fedele F. Stress echocardiography: comparison of exercise, dipyridamole and dobutamine in detecting and predicting the extent of coronary artery disease. J Am Coll Cardiol. 1995 Jul;26(1):18-25. doi: 10.1016/0735-1097(95)00121-f.
citation: Attenhofer CH, Pellikka PA, Oh JK, Roger VL, Sohn DW, Seward JB. Comparison of ischemic response during exercise and dobutamine echocardiography in patients with left main coronary artery disease. J Am Coll Cardiol. 1996 Apr;27(5):1171-7. doi: 10.1016/0735-1097(95)00583-8.
citation: Olson CE, Porter TR, Deligonul U, Xie F, Anderson JR. Left ventricular volume changes during dobutamine stress echocardiography identify patients with more extensive coronary artery disease. J Am Coll Cardiol. 1994 Nov 1;24(5):1268-73. doi: 10.1016/0735-1097(94)90108-2.
citation: Joseph T, Vieillard-Baron A, Chikli F, Goeau-Brissoniere O, Coggia M, Lacombe P, Dubourg O. Left ventricular volume analysis for the detection of coronary artery disease during dobutamine stress echocardiography in patients undergoing vascular surgery. Eur J Echocardiogr. 2000 Dec;1(4):263-70. doi: 10.1053/euje.2000.0039.
citation: Coletta C, Galati A, Ricci R, Sestili A, Guagnozzi G, Re F, Ceci V. Prognostic value of left ventricular volume response during dobutamine stress echocardiography. Eur Heart J. 1997 Oct;18(10):1599-605. doi: 10.1093/oxfordjournals.eurheartj.a015139.
citation: Rim SJ, Ha JW, Lee MH, Jang Y, Chung N. Left ventricular remodeling can be predicted with left ventricular volume response during dobutamine echocardiography after acute myocardial infarction. Clin Cardiol. 2008 Jun;31(6):259-64. doi: 10.1002/clc.20207.
citation: Dagianti A, Rosanio S, Tocchi M, Trambaiolo P, Vitarelli A, Fedele F. [Left ventricular volumetric and contractility behavior during stress echocardiography with dobutamine]. Cardiologia. 1996 Mar;41(3):251-8. Italian.
citation: Dehmer GJ, Lewis SE, Hillis LD, Corbett J, Parkey RW, Willerson JT. Exercise-induced alterations in left ventricular volumes and the pressure-volume relationship: a sensitive indicator of left ventricular dysfunction in patients with coronary artery disease. Circulation. 1981 May;63(5):1008-18. doi: 10.1161/01.cir.63.5.1008. No abstract available.