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(Circulation. 2006;113:1718-1720.)
© 2006 American Heart Association, Inc.

Editorial

Dobutamine Stress Echocardiography in Patients With Low-Gradient Aortic Stenosis

Richard A. Lange, MD; L. David Hillis, MD

From the Departments of Internal Medicine (Cardiology Divisions), Johns Hopkins Medical Institution, Baltimore, Md (R.A.L.), and the University of Texas Southwestern Medical Center, Dallas (L.D.H.).

Correspondence to L. David Hillis, MD, Room G5.232, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390–9030. E-mail dhilli@parknet.pmh.org

Key Words: Editorials • echocardiography • surgery • valves

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
In adults with moderate or severe aortic stenosis (AS), valve replacement surgery is recommended when symptoms (ie, angina, syncope, or congestive heart failure) appear.¹ In such patients, valve replacement surgery alleviates symptoms and improves survival, even in those with a depressed left ventricular ejection fraction (LVEF). Although a minority of patients with symptomatic AS have a reduced LVEF, these individuals present challenges in evaluation and management.

Article p 1738

In the patient with AS and a depressed LVEF, the latter may be caused by inadequate compensatory LV hypertrophy (so-called afterload mismatch) in which myocyte function is normal but LVEF is low because of inadequate LV mass. In such an individual, symptomatic status and LVEF improve with valve replacement surgery because the operation eliminates the preexisting excessive LV afterload, thereby restoring the match between LV myocyte mass and afterload. Alternatively, a depressed LVEF may be caused by a superimposed and separate myocardial disease process such as cardiomyopathy, ischemia, or fibrosis in which myocyte function is abnormal. In these individuals, operative risk is increased, symptomatic status often does not improve, and LVEF remains depressed after valve replacement surgery.

	Low-Gradient AS

 
Several previously published studies in subjects with AS and depressed LVEF have attempted to identify variables that may help to differentiate patients with afterload mismatch from those whose depressed LVEF is due to a separate disease process. Carabello and colleagues² found that individuals with severe AS, depressed LVEF, and a transvalvular pressure gradient >30 mm Hg were likely to survive valve replacement surgery and . . . [Full Text of this Article]

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