Early dobutamine echocardiography for the assessment of coronary stenosis after first Q-wave myocardial infarction.
We assessed the accuracy of early dobutamine stress echocardiography to detect infarct-related coronary artery and multivessel disease in patients with first Q wave myocardial infarction after withdrawal of cardioactive drugs. Dobutamine-atropine echocardiography was performed in 91 consecutive patients (mean age 59+/-6 years) 7+/-4 days after myocardial infarction. Dobutamine was infused at incremental doses of 5, 10, 20, 30 to 40 microg/kg/min each one dose for 3 min. Peak heart rate was 134+/-17 bpm. All patients underwent coronary angiography before discharge. Sensitivity, specificity and accuracy of ischemic and biphasic response to detect residual stenosis of infarct-related coronary artery were 70, 92 and 73%, respectively. The sensitivity, specificity and accuracy of ischemic or biphasic response were similar in the vascular territories of left anterior descending (74, 86 and 75%, respectively), right (67, 100 and 70%, respectively) and circumflex coronary arteries (64, 100, and 69%, respectively). Sensitivity, specificity and accuracy of heterozonal wall motion abnormalities for multivessel coronary artery disease were 64, 82 and 76%, respectively. Dobutamine stress echocardiography is sensitive and specific in detecting residual coronary stenosis and multivessel disease in patients with first Q-wave myocardial infarction. The test is safe even without pharmacological protection.
De Felice
F
F
Division of Cardiology, Ospedale Civico di Chivasso, Corso Galileo Ferraris 3, 10034 Chivasso, Torino, Italy. f.defelice@eudoramail.com
Gostoli
E
E
Russo
M
M
Recanzone
P
P
Moretti
C
C
Pinneri
F
F
Borello
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging*; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D012680:Sensitivity and Specificity
D002316:Cardiotonic Agents; D004280:Dobutamine