title: Incremental value of myocardial contrast echocardiography for the prediction of recovery of function in dobutamine nonresponsive myocardium early after acute myocardial infarction.
abstract: We hypothesized that the presence of microvascular integrity, detected by myocardial contrast echocardiography (MCE) in dobutamine nonresponsive segments, may enhance identification of recovery of function, which is a surrogate marker of myocardial viability. Accordingly, 96 patients underwent dobutamine echocardiography (DE) and intravenous MCE on the same day, 4.6 +/- 1.5 days after acute myocardial infarction (AMI). Recovery of function of akinetic segments was assessed at 3 months after AMI. Of 387 akinetic segments, 102 (26%) recovered function during follow-up. Sensitivities and specificities of MCE, DE, and the combination of DE and MCE in dobutamine nonresponsive segments were 58%, 59%, and 79%, respectively (p <0.001, compared with MCE and DE) and 76%, 84%, and 69%, respectively (p <0.05 compared with DE) for predicting recovery of function. In anterior AMI, the positive and negative predictive values of MCE, DE, and the combination of DE and MCE were 47% and 88%, 57% and 89%, and 49% and 95%, respectively. Multivariate analysis using clinical characteristics, electrocardiography, biochemical factors, MCE, and DE showed that the combination of DE and MCE in dobutamine nonresponsive segments (p <0.00001) and Q-wave AMI (p = 0.002) were the only independent predictors of recovery of function. Thus, for optimum prediction of recovery of function after AMI, a combination of DE and MCE in dobutamine nonresponsive segments may be utilized.
authors.affiliation: Department of Cardiovascular Medicine, Northwick Park and St. Mark's Hospitals and Institute of Medical Research, Harrow, United Kingdom. roxy.senior@virgin.net
authors.forename: Roxy
authors.initials: R
authors.lastname: Senior
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Swinburn
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents; D017023:Coronary Angiography; D003326:Coronary Circulation; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods* / Q000592:standards; D025401:Echocardiography, Stress / Q000379:methods* / Q000592:standards; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000628:therapy; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function; D012720:Severity of Illness Index; D016037:Single-Blind Method
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine