[Identification of ischemic and/or viable myocardium in early post-infarction period using echocardiographic imaging technique. Comparison of 2 tests: echo-dipyridamole and echo-dobutamine].
OBJECTIVE
To compare two stress tests: Dipyridamole-echocardiography (ECHO-DIP) and Dobutamine-echocardiography (ECHO-DOB) with angiographic data (still "gold standard") in early postinfarction period in order to identify ischemic and/or viable myocardium (considering the echocardiographic follow-up as "gold standard").


METHODS
40 consecutive patients (pts), mean age 56, at their first uncomplicated acute myocardial infarction (AMI) treated with thrombolytic agents were studied. All underwent coronary angiography.


RESULTS
The ECHO-DIP test resulted positive in 17 pts for transient regional asynergy (homozone 13/17; heterozonal positivity 4/17). The mean basal Wall Motion Score Index (WMSI) was 0.46 +/- 0.30 and at asynergy was 0.58 +/- 0.33 (p < 0.001). The ECHO-DOB test resulted positive in 20 pts; mean basal WMSI was 0.42 +/- 0.31 and at asynergy 0.55 +/- 0.35 (p < 0.001). Both tests were positive in 14 pts; the site of regional asynergy was the same in each test. During ECHO-DOB hypercinesia appeared in 27/39 pts (WMSI form basal 0.42 +/- 0.31 to 0.22 +/- 0.21 p < 0.001). Recovery of contractile function seems to identify viable myocardium: viable tissue shows early functional recovery during ECHO-DOB infusion. In 14 pts it remained until the end of the test, and in 12 it was transient, denoting the presence of myocardium "at risk". Remote (3- or 6-month) clinical and echocardiographic follow-up were carried out in all pts (25 undergoing medical therapy and 15 after PTCA or coronary bypass). In 26 pts with hyperkinesia at ECHO-DOB, basal echocardiogram revealed improvement of WMSI from 0.42 +/- 0.31 to 0.32 +/- 0.29 (p < 0.001).


CONCLUSIONS
"Passive" ECHO-stress tests in the early postinfarction period are easy to perform and free of major risks, they allow pts at risk due to residual ischemia to be revealed with a high degree of specificity and sensitivity. The improvement of kinesis during inotropic stimulus of Dobutamine suggests stunned or hibernating myocardium.
Rosselli
P
P
Servizio di Cardiologia e Utic, USL 18, Lavagna GE.
Garfagnini
A
A
Bianchi
F
F
Bollini
R
R
Zigliara
A
A
De Marchi
E
E
Boggiano
P
P
D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D004176:Dipyridamole; D004280:Dobutamine; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy
D004280:Dobutamine; D004176:Dipyridamole
Identificazione di miocardio ischemico e/o vitale nel post-infarto precoce mediante tecnica di imaging ecocardiografico. Confronto fra due test: eco-dipiridamolo ed eco-dobutamina.