title: Identification of viable myocardium in patients with chronic coronary artery disease and myocardial dysfunction: comparison of low-dose dobutamine stress echocardiography and echocardiography during glucose-insulin-potassium infusion.
abstract: Low-dose dobutamine stress echocardiography (LDDSE) is one of the methods most used to assess myocardial viability. Glucose-insulin-potassium (GIK) has been shown to increase contraction of the ischemic zone. The aim of this study was to compare LDDSE and echocardiography during GIK infusion for detection of myocardial viability in patients with chronic coronary artery disease (CAD) and myocardial dysfunction. Twenty-one patients who had chronic CAD and myocardial dysfunction were included in the study. Glucose-insulin-potassium protocol consisted of a fixed dose of insulin (100 microU/kg/hour IV) and a variable glucose/potassium infusion rate. GIK echocardiography was made at baseline and after 60 minutes of GIK infusion. During continuous electrocardiographic, blood pressure, and echocardiographic monitoring, an intravenous infusion of dobutamine (3 microg/kg body weight/min) was started with an infusion pump and continued for 5 minutes and then increased to 5 microg/kg/min and 10 microg/kg/min for another 5 minutes. The detected viable myocardium was defined as 1 or 2 scores decreasing in at least 2 adjacent abnormal segments during LDDSE and GIK echocardiography. Viability was detected in 19% (52 segments) of the asynergic segments at baseline with GIK echocardiography and 16% (44 segments) of those segments with LDDSE (p>0.05). Left ventricular wall motion score index at baseline was 2.24+/-0.35 and it decreased significantly during both LDDSE (p=0.004 vs 2.11+/-0.36) and GIK echocardiography (p=0.001 vs 2.09+/-0.32). The agreement between LDDSE and GIK echocardiography for detection of myocardial viability was 95%. This study shows that GIK echocardiography is similar to LDDSE for detection of myocardial viability. With the support of further clinical studies GIK echocardiography can be used to detect myocardial viability in patients with chronic CAD.
authors.affiliation: Inonu University Faculty of Medicine, Department of Cardiology, Malatya, Turkey. eryetkin@ttnet.net.tr
authors.forename: Ertan
authors.initials: E
authors.lastname: Yetkin
authors.forename: Kubilay
authors.initials: K
authors.lastname: Senen
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ileri
authors.forename: Ramazan
authors.initials: R
authors.lastname: Atak
authors.forename: Bektas
authors.initials: B
authors.lastname: Battaoglu
authors.forename: Ozkan
authors.initials: O
authors.lastname: Yetkin
authors.forename: Izzet
authors.initials: I
authors.lastname: Tandogan
authors.forename: Hasan
authors.initials: H
authors.lastname: Turhan
authors.forename: Sengül
authors.initials: S
authors.lastname: Cehreli
mesh_terms: D002314:Cardioplegic Solutions; D003327:Coronary Disease / Q000000981:diagnostic imaging*; D004452:Echocardiography; D025401:Echocardiography, Stress; D005260:Female; D005947:Glucose; D006801:Humans; D007328:Insulin; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000000981:diagnostic imaging*; D011188:Potassium; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
chemical_list: D002314:Cardioplegic Solutions; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium