Low-dose adenosine stress echocardiography: detection of myocardial viability.
OBJECTIVE
The aim of this study was to evaluate the diagnostic potential of low-dose adenosine stress echocardiography in detection of myocardial viability.


BACKGROUND
Vasodilation through low dose dipyridamole infusion may recruit contractile reserve by increasing coronary flow or by increasing levels of endogenous adenosine.


METHODS
Forty-three patients with resting dyssynergy, due to previous myocardial infarction, underwent low-dose adenosine (80, 100, 110 mcg/kg/min in 3 minutes intervals) echocardiography test. Gold standard for myocardial viability was improvement in systolic thickening of dyssinergic segments of >or= 1 grade at follow-up. Coronary angiography was done in 41 pts. Twenty-seven patients were revascularized and 16 were medically treated. Echocardiographic follow up data (12 +/- 2 months) were available in 24 revascularized patients.


RESULTS
Wall motion score index improved from rest 1.55 +/- 0.30 to 1.33 +/- 0.26 at low-dose adenosine (p < 0.001). Of the 257 segments with baseline dyssynergy, adenosine echocardiography identified 122 segments as positive for viability, and 135 as necrotic since no improvement of systolic thickening was observed. Follow-up wall motion score index was 1.31 +/- 0.30 (p < 0.001 vs. rest). The sensitivity of adenosine echo test for identification of viable segments was 87%, while specificity was 95%, and diagnostic accuracy 90%. Positive and negative predictive values were 97% and 80%, respectively.


CONCLUSIONS
Low-dose adenosine stress echocardiography test has high diagnostic potential for detection of myocardial viability in the group of patients with left ventricle dysfunction due to previous myocardial infarction. Low dose adenosine stress echocardiography may be adequate alternative to low-dose dobutamine test for evaluation of myocardial viability.
Djordjevic-Dikic
Ana
A
Institute for Cardiovascular Diseases, Dept. for Diagnostic and Catheterization Laboratories, Clinical Center of Serbia, 8 Koste Todorovica, 11000 Belgrade, Yugoslavia. skali@bitsyu.net
Ostojic
Miodrag
M
Beleslin
Branko
B
Nedeljkovic
Ivana
I
Stepanovic
Jelena
J
Stojkovic
Sinisa
S
Petrasinovic
Zorica
Z
Nedeljkovic
Milan
M
Saponjski
Jovica
J
Giga
Vojislav
V
D000241:Adenosine / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography / Q000379:methods*; D005080:Exercise Test / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology
D014665:Vasodilator Agents; D000241:Adenosine