title: Prediction of functional recovery of viable myocardium after delayed revascularization in postinfarction patients: accuracy of dobutamine stress echocardiography and influence of long-term vessel patency.
abstract: OBJECTIVE
  We sought to evaluate dobutamine stress echocardiography (DSE) for predicting recovery of viable myocardium after revascularization with cineangiography as a gold standard for left ventricular (LV) function. We studied the influence of late vessel reocclusion on regional LV function.
  
  
  BACKGROUND
  Dobutamine stress echocardiography is a well established evaluation method for myocardial viability assessment. In previous studies the reference method for assessing LV recovery was echocardiography, long-term vessel patency has not been systematically addressed.
  
  
  METHODS
  Sixty-eight patients with a first acute myocardial infarction (AMI) and residual stenosis of the infarct related artery (IRA) underwent DSE (mean +/- standard deviation) 21 +/- 12 days after AMI to evaluate myocardial viability. Revascularization of the IRA was performed in 54 patients by angioplasty (n = 43) or bypass grafting (n = 11). Coronary angiography and LV cineangiography were repeated at four months to assess LV function and IRA patency.
  
  
  RESULTS
  Sensitivity and specificity of DSE for predicting myocardial recovery after revascularization were 83% and 82%. In the case of late IRA patency, specificity increased to 95%, whereas sensitivity remained unchanged. In the 16 patients with myocardial viability and late IRA patency, echocardiographic wall motion score index decreased after revascularization from 1.83 +/- 0.15 to 1.36 +/- 0.17 (p = 0.0001), and left ventricular ejection fraction (LVEF) increased from 0.52 +/- 0.06 to 0.57 +/- 0.06 (p = 0.0004), whereas in five patients, reocclusion of the IRA prevented improvement of segmental or global LV function despite initially viable myocardium.
  
  
  CONCLUSIONS
  Dobutamine stress echocardiography is reliable to predict recovery of viable myocardium after revascularization in postinfarction patients. Late reocclusion of the IRA may prevent LV recovery and influence the accuracy of DSE.
authors.affiliation: Fédération de Cardiologie, Hôpital Henri Mondor, Créteil, France. pascal.gueret@hmn.ap.hop.paris.fr
authors.forename: J L
authors.initials: JL
authors.lastname: Monin
authors.forename: J
authors.initials: J
authors.lastname: Garot
authors.forename: M
authors.initials: M
authors.lastname: Scherrer-Crosbie
authors.forename: J
authors.initials: J
authors.lastname: Rosso
authors.forename: A M
authors.initials: AM
authors.lastname: Duval-Moulin
authors.forename: P
authors.initials: P
authors.lastname: Dupouy
authors.forename: E
authors.initials: E
authors.lastname: Teiger
authors.forename: A
authors.initials: A
authors.lastname: Castaigne
authors.forename: J C
authors.initials: JC
authors.lastname: Cachin
authors.forename: J L
authors.initials: JL
authors.lastname: Dubois-Rande
authors.forename: P
authors.initials: P
authors.lastname: Gueret
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002316:Cardiotonic Agents; D002932:Cineangiography; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D004280:Dobutamine; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D015588:Observer Variation; D012680:Sensitivity and Specificity; D014022:Tissue Survival / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine