Incremental value of myocardial contrast echocardiography for the prediction of recovery of function in dobutamine nonresponsive myocardium early after acute myocardial infarction.
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.
Senior
Roxy
R
Department of Cardiovascular Medicine, Northwick Park and St. Mark's Hospitals and Institute of Medical Research, Harrow, United Kingdom. roxy.senior@virgin.net
Swinburn
Jonathan M
JM
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
D002316:Cardiotonic Agents; D004280:Dobutamine