C  2008, the Authors Journal compilation C  2008, Wiley Periodicals, Inc. DOI: 10.1111/j.1540-8175.2008.00808.x Dobutamine Stress Echocardiography Identifies Patients with Angina and Dynamic Left Ventricular Outflow Obstruction in Physiological Exercise Fernando J. Cabrera-Bueno, M.D., Ph.D., ∗ Juan J. G´ omez-Doblas, M.D., ∗ Jose M. Garcia-Pinilla, M.D., Ph.D., ∗ Angel Montiel-Trujillo, M.D., Ph.D., ∗ Manuel Jim´ enez-Navarro, M.D., Ph.D., ∗ Dolores Martinez-del-Valle, M.D., Ph.D.,† Jose M. Jim´ enez-Hoyuela, M.D., Ph.D.,† and Eduardo de Teresa-Galv´ an, M.D., Ph.D., F.A.C.C., F.E.S.C. ∗ Departments of ∗ Cardiology and †Nuclear Medicine, University Hospital “Virgen de la Victoria,” Malaga, Spain Background and Methods: To determine whether patients with no heart disease who develop dynamic left ventricular outflow obstruction (DLVOTO) during dobutamine echocardiography (DE) reproduce the phenomenon during exercise echocardiography (EE), DE and EE were performed in 78 patients (59 ± 9 years) with effort angina and no alterations in SPECT. Thirty-eight (48.7%) patients had DLVOTO during DE and 15 (19.2%) during EE. This phenomenon during EE was reproducible in 39.4% of the patients with DLVOTO on DE, and 100% of the patients with DLVOTO during EE had it during DE. Independent factors predicting DLVOTO during EE were the LVOT diameter (OR 0.33 (0.14–0.74)) and the left ventricular (LV) mass index (OR 1.05 (1.01–1.08)). No cardiovascular events were noted after 26 ± 3 months. The reproducibility of DLVOTO during EE in patients with unexplained angina and with DLVOTO on DE is associated with the size of the LVOT and the LV mass index. The long-term prognosis is excellent. (ECHOCARDIOGRAPHY, Volume 26, March 2009) echocardiography, exercise, angina The development of dynamic left ventricu- lar outflow tract (LVOT) obstruction (DLVOTO) in the absence of hypertrophic cardiomyopa- thy during dobutamine stress echocardiogra- phy, described by Pellika et al. 1 in 1992, has been associated with hypotension, 2 angina, 3 and exertional dyspnea. 4 Although the onset of this phenomenon during effort is not usual in healthy persons, 5 it has been reported dur- ing exercise echocardiography in patients with angina or exertional dyspnea with no structural heart disease or any evidence of coronary artery disease. 6–8 In both these situations, it may lessen or disappear, in parallel with the symp- toms, when the patients are treated with beta- Address for correspondence and reprint requests: Fernando J. Cabrera-Bueno, M.D., Ph.D., Department of Cardiology, Hospital Universitario Virgen de la Victoria, Campus Uni- versitario Teatinos s/n, Malaga 29010, Spain. Fax: +34- 951-032-441; E-mail: fjcabrera@secardiologia.es blockers. 9,10 However, the onset of this phe- nomenon during dobutamine stress echocardio- graphy does not appear to identify patients who may develop it under normal physiological conditions, such as exercise. 11,12 We undertook this study with the hypothe- sis that some patients who have DLVOTO dur- ing dobutamine stress echocardiography but who have no data of ischemia may reproduce the same phenomenon during physical activity, thereby explaining their symptoms. Objectives The aim of this study was to determine whether the onset of DLVOTO during dobu- tamine stress echocardiography identifies pa- tients with unexplained angina and a dynamic gradient during exercise, assess the associated factors, and analyze the long-term prognosis for these patients. 272 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. Vol. 26, No. 3, 2009