Dobutamine-induced midcavitary gradients do not cause dyspnea

Introduction Left ventricular outflow tract (LVOT) and midcavitary gradients are common during dobutamine stress echocardiography. Some consider these gradients to be of no clinical significance. However, severe dobutamine-induced obstruction has been associated with chest pain and dyspnea, abnormalities in ventricular wall motion, and shock. These associations suggest that dobutamine-induced gradients may have a clinical significance in some patients. Right ventricular (RV) apical pacing has been reported to reduce LVOT gradients in patients with hypertrophic cardiomyopathy but is currently regarded as a class IIb indication for medically