Dobutamine effects on systolic and diastolic left ventricular long-axis excursion and timing – significance for the interpretation of s′ and e′

Figures & data

Figure 1. An example of pulsed wave tissue Doppler signals from the septal border of the mitral annulus in a healthy young adult subject showing systolic and diastolic time intervals from the onset of the Q wave on the electrocardiogram and velocity time integrals and peak velocities of the systolic, early diastolic and atrial contraction signals. SS: pulsed wave tissue Doppler imaging systolic signal; EDS: pulsed wave tissue Doppler imaging early diastolic signal; SExc: mitral annular systolic excursion; EDExc: mitral annular early diastolic excursion; AExc: mitral annular excursion during atrial contraction; s′: peak velocity of systolic mitral annular motion; e′: peak velocity of early diastolic mitral annular motion; a': peak velocity of mitral annular motion during atrial contraction

Table 1. Characteristics of the study groups.

	Group 1	Group 2
N	10	10
Male/Female	10/0	4/6
Age	22.2 ± 3.4	55.1 ± 7.3
Height (cm)	178 ± 9	167 ± 12
Weight (kg)	70.7 ± 14.1	102 ± 17
Body surface area (m^2)	1.87 ± 0.22	2.14 ± 0.24
Body mass index (kg/m^2)	22.1 ± 2.5	36.5 ± 4.9
Hypertension		7
Type 2 diabetes		3
Smoker		3
Hypercholesterolemia		8
Angiotensin converting enzyme inhibitor		2
Angiotensin receptor blocker		3
Thiazide diuretic		2
Amlodipine		1
Verapamil		1

Figure 2. Bar graphs with error bars representing the mean and standard deviations of the systolic and early diastolic excursions and the peak systolic and early diastolic velocities at baseline and for dobutamine doses of 5 and 10 ug/kg/min for the septal and lateral left ventricular walls in group 1. SExc, mitral annular systolic excursion; EDExc, mitral annular early diastolic excursion; s′, peak velocity of systolic mitral annular motion; e′, peak velocity of early diastolic mitral annular motion.

Table 2. Effects of dobutamine infusion on heart rate, blood pressure and left ventricular long-axis excursion and velocities in group 1.

	Baseline	Dobutamine 5 µg/kg/min	Dobutamine 10 µg/kg/min	RMANOVA p Value
Systolic BP (mmHg)	118 ± 19	151 ± 21*	168 ± 23*!	<0.001
Diastolic BP (mmHg)	56 ± 11	63 ± 11	62 ± 10	0.012
Pulse pressure (mmHg)	63 ± 12	88 ± 15*	106 ± 17*!	<0.001
Mean systemic BP (mmHg)	77 ± 13	93 ± 14*	98 ± 13*!	<0.001
HR (bpm)	55 ± 12	57 ± 9	65 ± 10*!	<0.001
Septal s′ (cm/s)	9.0 ± 1.7	12.8 ± 1.6*	14.4 ± 3.1*	<0.001
Septal SExc (cm)	1.8 ± 0.2	2.0 ± 0.3*	1.8 ± 0.4	0.003
Septal e′ (cm/s)	15.3 ± 1.2	16.6 ± 1.8	16.7 ± 2.2*	0.049
Septal EDExc (cm)	1.3 ± 0.2	1.5 ± 0.2*	1.4 ± 0.2	0.003
Septal a' (cm/s)	6.8 ± 1.5	8.4 ± 1.6*	8.2 ± 2.7	0.041
Septal AExc (cm)	0.4 ± 0.1	0.5 ± 0.1	0.5 ± 0.1	0.064
Lateral s′ (cm/s)	11.4 ± 1.8	15.6 ± 2.6*	18.5 ± 2.6*!	<0.001
Lateral SExc (cm)	1.8 ± 0.2	2.1 ± 0.3*	2.1 ± 0.2*	<0.001
Lateral e′ (cm/s)	18.5 ± 1.5	23.3 ± 2.7*	23.6 ± 1.4*	<0.001
Lateral EDExc (cm)	1.4 ± 0.2	1.6 ± 0.2*	1.7 ± 0.3*	<0.001
Lateral a' (cm/s)	6.3 ± 1.6	7.3 ± 2.5	8.7 ± 2.4*	0.002
Lateral AExc (cm)	0.4 ± 0.1	0.4 ± 0.1	0.4 ± 0.1	0.47

Values reported as mean ± SD, *p < 0.05 compared to baseline,! p < 0.05 compared to dobutamine 5 ug/kg/min.

a': peak velocity of mitral annular motion during atrial contraction; AExc: mitral annular excursion during atrial contraction; BP: blood pressure; e′: peak velocity of early diastolic mitral annular motion; EDExc: early diastolic mitral annular excursion; HR: heart rate; s′: peak velocity of systolic mitral annular motion; SExc: systolic mitral annular excursion.

Table 3. Effects of dobutamine infusion on left ventricular long-axis time intervals in group 1.

	Baseline	Dobutamine 5 µg/kg/min	Dobutamine 10 µg/kg/min	RMANOVA p value
Septal Q-onset SS (ms)	85 ± 13	71 ± 16*	62 ± 5*	<0.001
Septal Q-peak SS (ms)	154 ± 35	113 ± 20	98 ± 9*	<0.001
Septal Q-end SS (ms)	385 ± 26	345 ± 20*	298 ± 48*!	<0.001
Septal Q-onset EDS (ms)	452 ± 36	406 ± 34*	367 ± 35*!	<0.001
Septal Q-peak EDS (ms)	516 ± 35	470 ± 33*	428 ± 38*!	<0.001
Septal Q-end EDS (ms)	617 ± 50	569 ± 38	525 ± 42*!	<0.001
Septal SDur (ms)	300 ± 18	274 ± 12*	246 ± 24*!	<0.001
Septal IVRT' (ms)	68 ± 11	60 ± 17	59 ± 16	0.086
Septal EDDur (ms)	164 ± 26	163 ± 19	159 ± 19	0.69
Septal EDAT (ms)	64 ± 7	64 ± 9	61 ± 11	0.63
Septal EDDT (ms)	100 ± 24	99 ± 17	97 ± 24	0.87
Lateral Q-onset SS (ms)	87 ± 9	72 ± 13*	64 ± 8*	<0.001
Lateral Q-peak SS (ms)	135 ± 16	110 ± 17*	99 ± 20*	<0.001
Lateral Q-end SS (ms)	393 ± 25	342 ± 25*	308 ± 27*!	<0.001
Lateral Q-onset EDS (ms)	462 ± 36	396 ± 32*	358 ± 35*	<0.001
Lateral Q-peak EDS (ms)	523 ± 38	466 ± 30*	426 ± 40*!	<0.001
Lateral Q-end EDS (ms)	594 ± 42	534 ± 38*	495 ± 36*	<0.001
Lateral SDur (ms)	306 ± 27	269 ± 16*	244 ± 24*!	<0.001
Lateral IVRT' (ms)	69 ± 14	54 ± 11	50 ± 13*	0.006
Lateral EDDur (ms)	132 ± 17	138 ± 18	136 ± 17	0.67
Lateral EDAT (ms)	60 ± 9	70 ± 13	68 ± 10	0.04
Lateral EDDT (ms)	72 ± 14	68 ± 19	68 ± 12	0.71

Values reported as mean ± SD, *p < 0.05 compared to baseline,! p < 0.05 compared to dobutamine 5 ug/kg/min.

EDAT: early diastolic mitral annular acceleration time; EDDT: early diastolic mitral annular deceleration time; EDDur: early diastolic mitral annular duration; EDS: pulsed wave tissue Doppler imaging early diastolic signal; IVRT': isovolumic relaxation time; SDur: systolic duration; SS: pulsed wave tissue Doppler imaging systolic signal.

Figure 3. Bar graphs with error bars representing the mean and standard deviations of the systolic and early diastolic excursions and the peak systolic and early diastolic velocities at baseline and for dobutamine doses of 5 and 10 ug/kg/min for the septal and lateral left ventricular walls in group 2. SExc: mitral annular systolic excursion; EDExc: mitral annular early diastolic excursion; s′: peak velocity of systolic mitral annular motion; e′: peak velocity of early diastolic mitral annular motion

Table 4. Effect of dobutamine infusion on heart rate, blood pressure and left ventricular long-axis excursion and velocities in group 2.

	Baseline	Dobutamine 5 ug/kg/min	Dobutamine 10 ug/kg/min	ANOVA p value
Systolic BP (mmHg)	126 ± 10	143 ± 23	143 ± 20	0.04
Diastolic BP (mmHg)	67 ± 5	67 ± 8	65 ± 10	0.054
Pulse pressure (mmHg)	57 ± 11	76 ± 23*	78 ± 21*	0.002
Mean systemic BP (mmHg)	87 ± 7	92 ± 10	91 ± 10	0.56
Heart rate	66 ± 10	76 ± 15*	90 ± 22*!	<0.001
Septal s′ (cm/s)	6.8 ± 0.7	10.7 ± 1.3*	12.8 ± 2.7*	<0.001
Septal SExc (cm)	1.2 ± 0.2	1.4 ± 0.2*	1.3 ± 0.2	0.002
Septal e′ (cm/s)	7.0 ± 1.2	9.4 ± 1.2*	8.6 ± 1.3*	<0.001
Septal EDExc (cm)	0.7 ± 0.1	0.9 ± 0.2*	0.8 ± 0.3	0.028
Septal a' (cm/s)	8.6 ± 1.2	10.0 ± 1.0	11.9 ± 2.0*!	0.001
Septal AExc (cm)	0.6 ± 0.1	0.6 ± 0.1	0.7 ± 0.2	0.011
Lateral s′ (cm/s)	8.3 ± 1.5	11.9 ± 2.1*	13.1 ± 2.4*	<0.001
Lateral SExc (cm)	1.2 ± 0.1	1.5 ± 0.2*	1.3 ± 0.2	0.002
Lateral e′ (cm/s)	9.4 ± 1.3	12.1 ± 1.4*	12.1 ± 1.8*	0.002
Lateral EDExc (cm)	0.8 ± 0.1	1.0 ± 0.2*	1.0 ± 0.3*	0.002
Lateral a' (cm/s)	9.9 ± 1.6	11.2 ± 2.5	12.4 ± 3.0*	0.005
Lateral AExc (cm)	0.5 ± 0.1	0.5 ± 0.2	0.6 ± 0.2*	0.01

Values reported as mean ± SD, *p < 0.05 compared to baseline,! p < 0.05 compared to dobutamine 5 µg/kg/min.

a': peak velocity of mitral annular motion during atrial contraction; AExc: mitral annular excursion during atrial contraction; BP; blood pressure; e′: peak velocity of early diastolic mitral annular motion; EDExc: early diastolic mitral annular excursion; HR: heart rate; s′: peak velocity of systolic mitral annular motion; SExc: systolic mitral annular excursion.

Table 5. Effect of dobutamine infusion on left ventricular long-axis time intervals in group 2.

	Baseline	Dobutamine 5 µg/kg/min	Dobutamine 10 µg/kg/min	ANOVA p value
Septal Q-onset SS (ms)	83 ± 17	60 ± 14*	50 ± 16*	<0.001
Septal Q-peak SS (ms)	131 ± 27	97 ± 24*	88 ± 23*	0.001
Septal Q-end SS (ms)	378 ± 28	312 ± 34*	269 ± 56*!	<0.001
Septal Q-onset EDS (ms)	483 ± 47	392 ± 42*	347 ± 60*!	<0.001
Septal Q-peak EDS (ms)	529 ± 34	456 ± 43*	400 ± 71*!	<0.001
Septal Q-end EDS (ms)	665 ± 29	579 ± 64*	513 ± 106*!	<0.001
Septal SDur (ms)	296 ± 28	252 ± 28*	219 ± 43*	<0.001
Septal IVRT' (ms)	102 ± 25	80 ± 21	79 ± 29	0.042
Septal EDDur (ms)	181 ± 24	187 ± 32	166 ± 61	0.17
Septal EDAT (ms)	55 ± 14	63 ± 10	52 ± 18	0.33
Septal EDDT (ms)	135 ± 20	124 ± 30	114 ± 49	0.31
Lateral Q-onset SS (ms)	89 ± 13	61 ± 12*	56 ± 21*	0.005
Lateral Q-peak SS (ms)	181 ± 47	118 ± 49*	105 ± 39*	0.004
Lateral Q-end SS (ms)	383 ± 25	311 ± 35*	271 ± 54*!	<0.001
Lateral Q-onset EDS (ms)	470 ± 39	383 ± 45*	339 ± 60*!	<0.001
Lateral Q-peak EDS (ms)	527 ± 38	452 ± 46*	404 ± 62*!	<0.001
Lateral Q-end EDS (ms)	634 ± 36	558 ± 55*	494 ± 73*!	<0.001
Lateral SDur (ms)	294 ± 26	250 ± 31*	215 ± 52*!	<0.001
Lateral IVRT' (ms)	87 ± 17	72 ± 13*	68 ± 14*	0.007
Lateral EDDur (ms)	164 ± 9	176 ± 24	155 ± 34	0.11
Lateral EDAT (ms)	57 ± 8	70 ± 9	52 ± 14	0.09
Lateral EDDT (ms)	107 ± 13	106 ± 24	90 ± 24	0.12

Values reported as mean ± SD, *p < 0.05 compared to baseline,! p < 0.05 compared to dobutamine 5 µg/kg/min.

EDAT: early diastolic mitral annular acceleration time; EDDT: early diastolic mitral annular deceleration time; EDDur: early diastolic mitral annular duration; EDS: pulsed wave tissue Doppler imaging early diastolic signal; IVRT': isovolumic relaxation time; SDur: systolic duration; SS: pulsed wave tissue Doppler imaging systolic signal.