title: Dobutamine-induced ST-segment elevation in patients with acute myocardial infarction and the role of myocardial ischemia, viability, and ventricular dyssynergy.
abstract: We analyzed the relation between dobutamine-induced Q-wave ST-segment elevation and regional contraction during low (5 to 10 microg/kg/min) and high doses (20 to 40 microg/kg/min) of dobutamine in a series of 391 dobutamine echocardiographic tests performed 10 +/- 2 days after a first uncomplicated acute myocardial infarction (AMI). ST-segment elevation was defined as > or = 1 mm new or additional J-point elevation with a horizontal or upsloping ST segment lasting 80 ms. Wall motion score index at rest was derived using a 16 segment-4 grade score model. Patients with dobutamine-induced ST-segment elevation had a higher wall motion score index at rest (anterior wall AMI: 1.67 +/- 0.27 vs 1.43 +/- 0.30, p = 0.0001; inferior wall AMI: 1.44 +/- 0.27 vs 1.30 +/- 0.18, p = 0.0001) and similar incidence and extent of myocardial viability and homozonal ischemia in comparison with those without ST-segment elevation. The sensitivity, specificity, and accuracy of dobutamine-induced ST-segment elevation for detecting residual homozonal ischemia were 51%, 55%, and 54%, respectively, in patients with anterior wall AMI, and 42%, 68%, and 58%, respectively, in patients with inferior wall AMI. In conclusion, dobutamine-induced ST-segment elevation is not associated with higher incidence and extent of viable or jeopardized myocardium but rather to a greater extent of wall motion abnormalities at rest. Thus, this finding does not represent a clinically reliable discriminator for selecting patients for coronary angiography and possible revascularization procedures.
authors.affiliation: Division of Cardiology, S. Spirito Hospital, Rome, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Ricci
authors.forename: R
authors.initials: R
authors.lastname: Bigi
authors.forename: A
authors.initials: A
authors.lastname: Galati
authors.forename: P
authors.initials: P
authors.lastname: Bandini
authors.forename: C
authors.initials: C
authors.lastname: Coletta
authors.forename: C
authors.initials: C
authors.lastname: Fiorentini
authors.forename: F
authors.initials: F
authors.lastname: Lumia
authors.forename: G
authors.initials: G
authors.lastname: Occhi
authors.forename: V
authors.initials: V
authors.lastname: Ceci
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography / Q000187:drug effects / Q000379:methods / Q000706:statistics & numerical data; D004562:Electrocardiography / Q000187:drug effects* / Q000379:methods / Q000706:statistics & numerical data; D005080:Exercise Test / Q000187:drug effects / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D017202:Myocardial Ischemia / Q000175:diagnosis*; D015588:Observer Variation; D012680:Sensitivity and Specificity; D018754:Ventricular Dysfunction / Q000175:diagnosis*
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine