Profound left ventricular systolic deterioration during dobutamine stress echocardiography despite normal resting speckle-tracking imaging revealing subclinical dilated cardiomyopathy and reversal under treatment

Profound left ventricular systolic deterioration during dobutamine stress echocardiography despite normal resting speckle-tracking imaging revealing subclinical dilated cardiomyopathy and reversal under treatment The two-dimensional speckle tracking echocardiography (2D-STE) method has recently emerged as a more sensitive modality than conventional echocardiography in detecting subclinical ventricular dysfunction in various clinical disorders [1]; in contrast, dobutamine stress echocar-diography (DSE) is increasingly considered as an old less " fashionable " technique and rather unsuitable for the detection of subclinical myocar-dial dysfunction and early stages of idiopathic dilated cardiomyopathy. We report the case of a 55 year-old man who underwent a preoper-ative cardiac evaluation; he had normal left ventricular ejection fraction, diastolic function and resting global strain and no wall motion abnormalities. At peak dobutamine infusion, a spectacular global dysfunction was shown in the absence of coronary artery disease. Control DSE after a 4 month-treatment with an angiotensin-converting enzyme (ACE) in-hibitor was normalized. Mr AE, a 55 year-old man was addressed to our department for a preoperative cardiac assessment prior to a lung biopsy in the setting of a recently discovered nodular mass in his right lung. He had neither hypertension nor diabetes mellitus but had a documented peripheral artery disease as he underwent an angioplasty of his iliac arteries several years ago and had an occluded left tibial artery. Clinically, the patient reported a mild effort dyspnea NYHA classes I– II but no chest pain, his resting ECG was normal. His treatment only consisted in aspirin (75 mg daily) and low dose atorvastatin (10 mg daily). Echocardiography at rest was unremarkable with normal cavity dimensions, left ventricular ejection fraction at 66%, no wall motion abnormalities and normal diastolic function (E wave = 90 cm/s, A wave = 61 cm/s, É = 10 cm/s and E/É = 9.1). Global longitudinal strain was also normal at − 20.2%. DSE with a standard protocol was performed , at peak dobutamine infusion, a spectacular and profound global ventricular dysfunction was observed with dilatation of the left ventri-cle and an estimated ejection fraction at 30% (Fig. 1; Video loop 1); meanwhile, the patient reported no chest pain, ECG didn't show any specific changes and arterial pressure profile was normal. A severe coronary artery disease was strongly suspected but cor