Early prediction of improvement in ejection fraction after acute myocardial infarction using low dose dobutamine echocardiography.
OBJECTIVE
To evaluate the relation between changes in ejection fraction during the first three months after acute myocardial infarction and myocardial viability.


METHODS
Myocardial viability was assessed using low dose dobutamine echocardiography in 107 patients at mean (SD) 3 (1) days after acute myocardial infarction. Cross sectional echocardiography was repeated three months later. Left ventricular volumes and ejection fraction were determined from apical views using the Simpson biplane formula.


RESULTS
In patients with viability, ejection fraction increased by 4.4 (4.3)%; in patients without viability it remained unchanged (0.04 (3.6)%; p < 0.001). A > or = 5% increase in ejection fraction was present in 21 of 107 patients (20%). Receiver operating characteristic analysis showed that myocardial viability in > or = 2 segments predicted this increase in ejection fraction with a sensitivity of 81% and a specificity of 65%. Multivariate logistic regression analysis was used to define which clinical and echocardiographic variables were related to > or = 5% improvement in ejection fraction. Myocardial viability, non-Q wave infarction, and anterior infarction all emerged as independent predictors, myocardial viability being the best (chi(2) = 14.5; p = 0.0001). Using the regression equation, the probability of > or = 5% improvement in ejection fraction for patients with a non-Q wave anterior infarct with viability was 73%, and for patients with a Q wave inferior infarct without viability, only 2%.


CONCLUSIONS
Myocardial viability after acute myocardial infarction is the single best predictor of improvement in ejection fraction. In combination with infarct location and Q wave presence, the probability of > or = 5% improvement can be estimated in individual patients at the bedside.
Nijland
F
F
Department of Cardiology and Institute for Cardiovascular Research, VU Medical Centre, Amsterdam, Netherlands. fr.nijland@12move.nl
Kamp
O
O
Verhorst
P M J
PM
de Voogt
W G
WG
Visser
C A
CA
D002316:Cardiotonic Agents / Q000008:administration & dosage; D002470:Cell Survival; D004298:Dopamine / Q000008:administration & dosage; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology
D002316:Cardiotonic Agents; D004298:Dopamine