title: Relation between ST segment elevation during dobutamine stress test and myocardial viability after a recent myocardial infarction.
abstract: OBJECTIVE
  To assess the relation between ST segment elevation during the dobutamine stress test and late improvement of function after acute Q wave myocardial infarction.
  
  
  METHODS
  70 patients were studied a mean (SD) 8 (3) days after acute myocardial infarction with high dose dobutamine-atropine stress echocardiography and a follow up echocardiogram at 85 (10) days. A score model based on 16 segments and four grades was used to assess left ventricular function. Functional improvement was defined as a reduction of wall motion score > or = 1 in > or = 1 segments at follow up.
  
  
  METHODS
  Myocardial revascularisation was performed in 23 patients (33%) before follow up studies.
  
  
  RESULTS
  ST segment elevation occurred in 40 patients (57%). Late functional improvement occurred in 35 patients (50%). Functional improvement was more common in patients with ST segment elevation (68% v 30%, P < 0.005) and they had a higher mean (SD) number of improved segments at follow up (1.9 (2.2) v 0.5 (1.1), P < 0.005). The wall motion score index decreased between baseline and follow up in patients with ST segment elevation (1.54 (0.50) v 1.48 (0.43), P < 0.05) but not in patients without ST segment elevation (1.39 (0.60) v 1.45 (0.47)). The accuracy of ST segment elevation for the prediction of functional improvement was similar to that of low dose dobutamine echocardiography in patients with anterior infarction (80% v 83%) and in patients who underwent revascularisation (78% v 83% respectively).
  
  
  CONCLUSIONS
  In patients with a recent Q wave myocardial infarction, dobutamine-induced ST segment elevation is a valuable marker of myocardial viability particularly when the test is performed without or with suboptimal echocardiographic imaging.
authors.affiliation: Thoraxcenter, University Hospital Rotterdam-Dijkzigt, Erasmus University, Rotterdam, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Elhendy
authors.forename: J H
authors.initials: JH
authors.lastname: Cornel
authors.forename: J R
authors.initials: JR
authors.lastname: Roelandt
authors.forename: R T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: M I
authors.initials: MI
authors.lastname: Geleijnse
authors.forename: P R
authors.initials: PR
authors.lastname: Nierop
authors.forename: J J
authors.initials: JJ
authors.lastname: Bax
authors.forename: A
authors.initials: A
authors.lastname: Sciarra
authors.forename: M M
authors.initials: MM
authors.lastname: Ibrahim
authors.forename: M
authors.initials: M
authors.lastname: el-Refaee
authors.forename: G M
authors.initials: GM
authors.lastname: el-Said
authors.forename: P M
authors.initials: PM
authors.lastname: Fioretti
mesh_terms: D002316:Cardiotonic Agents; D004280:Dobutamine; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D016277:Ventricular Function, Left
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine