title: [Chronic myocardial ischemia: indications and limits of dobutamine stress echocardiography].
abstract: Dobutamin echocardiography has turned out to be a reliable tool for the detection of myocardial viability in the setting of acute and chronic myocardial ischemia. Moreover, recent publications have highlighted the prognostic implications of the method in patients with acute myocardial infarction and in patients with chronic myocardial ischemia and reduced left ventricular function. In comparison to szintigraphy dobutamine echocardiography has shown higher specificity and accuracy for the prediction of functional recovery of chronic dysfunctional segments after revascularization procedures. Reasons for the discrepancy include the different methodological approaches of the two techniques for the detection of viability, i.e., functional recovery versus metabolic integrity and perfusion. Furthermore, existing evidence supports the concept that functional recovery is dependend on a threshold level of viable contracting myocardium, whereas metabolic integrity and perfusion will be even detected at a level below that necessary for functional recovery. Limitations of the method include poor transthoracic image quality in a variable subset of patients and the subjective nature of the analysis of wall motion abnormalities by the investigator.
authors.affiliation: Medizinische Klinik I Universitätsklinikum der RWTH, Aachen.
authors.forename: H P
authors.initials: HP
authors.lastname: Kühl
authors.forename: P
authors.initials: P
authors.lastname: Hanrath
mesh_terms: D002316:Cardiotonic Agents; D003326:Coronary Circulation / Q000502:physiology; D004280:Dobutamine; D004452:Echocardiography / Q000187:drug effects; D005080:Exercise Test / Q000187:drug effects; D006801:Humans; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012680:Sensitivity and Specificity; D014022:Tissue Survival / Q000502:physiology
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine
vernacular_title: Chronische Myokardischämie: Indikationen und Grenzen der Dobutamin-Stressechokardiographie.