Role of stress echocardiography in heart failure.
Most patients presenting with heart failure have severe coronary artery disease. The identification of viable hibernating myocardium is of paramount clinical importance for a correct indication of revascularization. Contractile reserve may be identified when regional asynergy improves during low or moderate doses of dobutamine. Dipyridamole, given at infra-low dose, alone or preferably in association with a low dose of dobutamine, is another possible pharmacologic stress protocol. Dobutamine echocardiography has been found to be more specific than thallium scintigraphy for predicting functional recovery after revascularization. However, the absence of contractile reserve does not exclude the presence of myocardial viability: perfusion reserve may be too low because of a critical coronary artery stenosis, or profound ultrastructural changes of myocardial cells may be present, including significant loss of contractile material. Inotropic reserve can also be assessed by dobutamine stress echocardiography in patients with idiopathic cardiomyopathy. The evolution of hemodynamic variables can be measured during the stress test. Stress echocardiography, especially during exercise, could probably provide important information about heart failure associated with valvular heart disease.
Pierard
L A
LA
Department of Cardiology, University Hospital, Liège, Belgium.
Hoffer
E P
EP
D002303:Cardiac Output, Low / Q000000981:diagnostic imaging* / Q000473:pathology; D002316:Cardiotonic Agents; D004176:Dipyridamole; D004280:Dobutamine; D015150:Echocardiography, Doppler / Q000379:methods; D006801:Humans; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity
D002316:Cardiotonic Agents; D004280:Dobutamine; D004176:Dipyridamole