Early assessment of viable myocardium after acute myocardial infarction by low-dose echo-dobutamine.
BACKGROUND
The aim of the study was to evaluate the usefulness of low-dose dobutamine echocardiographic testing performed within 48 hours from anterior AMI in order to identify the extent of viable myocardium and predict its functional outcome. The early echo-dobutamine test was also compared with a predischarge test in order to evaluate the effects of different timing on the accuracy of the test.


METHODS
Nineteen consecutive patients, aged 54 +/- 11 years, with a first anterior AMI entered the study. All patients underwent a low-dose dobutamine echocardiographic test within 48 hours from hospital admission and at predischarge. In all the patients, a rest follow-up echocardiogram was performed three months after hospital discharge. Eleven patients underwent a revascularization procedure (7 underwent PTCA and 4 CABG).


RESULTS
Of the 159 dyssynergic segments, 26% improved spontaneously at predischarge and 51% improved at the three-month follow-up. Of the 145 predischarge dyssynergic segments, 38% improved at three months. Considering the results on a segmental basis, early low-dose dobutamine echocardiography showed a sensitivity of 52%, a specificity of 87%, a positive predictive value of 81%, a negative predictive value of 64% and a diagnostic accuracy of 69% for wall-motion improvement at three months. The predischarge test showed very similar values. A slight enhancement of the sensitivity of both tests was observed considering the akinetic segments only. Finally, considering the amount of segmental reversible dysfunction inside the infarct area in the single patients, early low-dose dobutamine echocardiography showed a sensitivity of 86% and a specificity of 80%.


CONCLUSIONS
Our results indicate that: 1) recovery of regional wall motion after AMI is slow and progressive, with substantial improvement ensuing within the first days after infarction; 2) considering results on a segmental basis, low-dose dobutamine echocardiography performed within 48 hours of AMI shows a high specificity but a low sensitivity for late recovery of regional function, although it gave information similar to what was obtained performing the test at predischarge; 3) the efficiency of test can be improved by considering the amount of reversible segmental dysfunction inside the infarct area in the single patients.
Castini
D
D
Department of Cardiology, San Paolo Hospital, University of Milan.
Garbin
M
M
Bigi
R
R
Occhi
G
G
Concardi
G
G
Belletti
S
S
Gioventù
M
M
Sponzilli
C
C
Fiorentini
C
C
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents; D016001:Confidence Intervals; D017023:Coronary Angiography; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D012680:Sensitivity and Specificity; D013997:Time Factors; D014022:Tissue Survival / Q000502:physiology*
D002316:Cardiotonic Agents; D004280:Dobutamine