Computational Prediction of Dobutamine-Induced Hemodynamic Changes in Aortic Coarctation

Objectives: Pharmacological stress testing is used in patients with aortic coarctation (CoA) and other stenotic diseases to unmask cases with borderline indication for invasive treatment. We developed and tested a computational model to calculate dobutamine-induced pressure gradient increases in CoA.

Methods: Data of magnetic resonance imaging (MRI) and literature information obtained from a meta-analysis on hemodynamic effects of dobutamine stress testing were used to develop the model. The model was then tested in a validation cohort of n = 22 CoA patients who underwent dobutamine stress examination during cardiac catheterization.

Result: The mean pressure gradient increased significantly from 14.7 ± 5.3 mm Hg at rest to 31.3 ± 11.3 mm Hg during dobutamine stress testing (p < 0.001). Significant equivalence was found for the model-predicted pressure gradient of 29.4 ± 11.7 mm Hg during stress (two-sample paired mean equivalence test with a noninferiority margin of 5 mm Hg, p = 0.008). There was good agreement between the invasively measured and the predicted pressure gradients during stress with a mean difference of −1.9 mm Hg and a limit of agreement of ±10.6 mm Hg according to Bland–Altman analysis.

Conclusion: The computational model allows to predict dobutamine-induced pressure gradient increases with results similar to measurements of stress examinations during catheterization. This approach can already be useful in the assessment of the hemodynamic relevance of CoA and carries the promising potential to become a noninvasive alternative to conventional stress testing.

Publication History

Article published online:
21 February 2021