Myocardial viability after primary coronary angioplasty: low-dose dobutamine stress echocardiography versus myocardial contrast echocardiography.
BACKGROUND
Successful reperfusion therapy in patients with acute myocardial infarction (AMI) improves survival. Indeed, after AMI myocardial dysfunction may be reversible (hibernating or stunned myocardium). Low-dose dobutamine stress echocardiography (LDDSE) provides us with the possibility of evaluating viable myocardial segments, while myocardial contrast echocardiography (MCE) allows the study of the microcirculation in the same myocardial areas. The aim of our study was to compare LDDSE and MCE, in the prediction of the recovery of segments in patients with AMI who were submitted to primary coronary angioplasty (PTCA).


METHODS
We studied 14 patients with AMI. Both LDDSE and MCE with Levovist were performed after primary PTCA. The viability gold standard was a recovery of contractility detected at echocardiography 2 months later.


RESULTS
For LDDSE, the sensitivity was 91%, the specificity 71% and the positive and negative predictive values were 93 and 64% respectively. For MCE, the sensitivity was 94%, the specificity 44%, the positive predictive value 89%, and the negative predictive value 59%. Two tests agreed in 81% of the cases. Stress echocardiography and contrast echocardiography agreed in 81% of cases.


CONCLUSIONS
LDDSE has a very good positive accuracy, it has an acceptable negative predictive value and is relatively cheap. On the other hand, MCE has a good positive accuracy, but a low negative accuracy and carries a high cost. The integration of these two tests, which are too expensive in clinical practice, could improve our comprehension of the post-PTCA pathophysiology.
Division of Cardiology, Department of Internal Medicine, University of Turin, Turin, Italy. mara.morello@unito.it
Mara
M
Morello
Giuliana
G
Bricco
Marco
M
Calachanis
Irene
I
Paglia
Imad
I
Sheiban
Lucia
L
Mangiardi
Gian Paolo
GP
Trevi
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D003287:Contrast Media; D003326:Coronary Circulation / Q000502:physiology; D015150:Echocardiography, Doppler / Q000379:methods*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009200:Myocardial Contraction / Q000502:physiology*; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015607:Stents; D015996:Survival Rate; D016896:Treatment Outcome; D014654:Vascular Patency
D003287:Contrast Media