title: Dobutamine- vs exercise-induced ST segment elevation early after Q wave myocardial infarction. Prediction of functional recovery after revascularization.
abstract: OBJECTIVE
  The association between stress-induced ST elevation and functional recovery following revascularization after myocardial infarction remains unclear. We assessed the relative accuracy of dobutamine- and exercise-induced ST elevation in Q wave leads in predicting functional recovery following revascularization, and we investigated the relationship of ST elevation to different wall motion responses to dobutamine.
  
  
  RESULTS
  Thirty-nine patients underwent dobutamine stress echo and exercise test 8+/-2 days after Q wave myocardial infarction. All patients underwent angiography and subsequent revascularization. Follow-up echocardiograms were obtained 7+/-4 weeks after revascularization. Functional recovery was assessed by the difference between the baseline and the follow-up asynergy index. Nineteen patients (48%) developed dobutamine- and exercise-induced ST elevation. There was significant agreement between the tests (k=0.58, P<0.001). We found a significant correlation between dobutamine and exercise-induced ST elevation with functional recovery following revascularization (r=0. 45, P<0.005 and r=0.7, P<0.001, respectively). The parameters with the highest predictive value for functional recovery were: (a) the biphasic response during dobutamine infusion, (b) the development of ST elevation in both tests, and (c) the development of exercise-induced ST elevation in more than three leads.
  
  
  CONCLUSIONS
  There is a strong association between dobutamine- and exercise-induced ST elevation with functional recovery following revascularization. Exercise-induced ST elevation in more than three leads and a biphasic response during dobutamine infusion accurately predict functional recovery.
authors.affiliation: Cardiology Department, University Hospital of Heraklion, Crete, Greece.
authors.forename: N E
authors.initials: NE
authors.lastname: Mezilis
authors.forename: F I
authors.initials: FI
authors.lastname: Parthenakis
authors.forename: M K
authors.initials: MK
authors.lastname: Kanakaraki
authors.forename: M E
authors.initials: ME
authors.lastname: Marketou
authors.forename: H E
authors.initials: HE
authors.lastname: Mavrakis
authors.forename: P E
authors.initials: PE
authors.lastname: Vardas
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D002316:Cardiotonic Agents; D004280:Dobutamine; D004562:Electrocardiography; D005080:Exercise Test; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000628:therapy; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D016277:Ventricular Function, Left
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine