title: Comparison of real-time contrast echocardiography and low-dose dobutamine stress echocardiography in predicting the left ventricular functional recovery in patients after acute myocardial infarction under different therapeutic intervention.
abstract: BACKGROUND
  Early prediction of left ventricular (LV) functional recovery after acute myocardial infarction (AMI) remains challenging. This prospective study aims to compare real-time myocardial contrast echocardiography (MCE) with low-dose dobutamine stress echocardiography (LDDSE) in predicting the LV functional recovery in patients after AMI who underwent different therapeutic interventions.
  
  
  METHODS
  Ninety-two patients with AMI were divided into 3 groups: primary coronary intervention group (n=34), thrombolysis group (n=30) and conservative therapy group (n=28). MCE was performed 2.3+/-0.7 days after chest pain onset. LDDSE was done within 2 days of MCE study. Follow-up echocardiography was performed 4 months later.
  
  
  RESULTS
  Patients treated by primary coronary intervention or thrombolysis had significantly lower regional perfusion score (0.65+/-0.53 vs. 1.01+/-0.49, p=0.008; 0.78+/-0.55 vs. 1.01+/-0.49, p=0.03), better contractile reserve (regional dobutamine Deltawall motion score -1.12+/-0.39 vs. -0.80+/-0.43, p=0.01; -0.99+/-0.50 vs. -0.80+/-0.43, p=0.08) and LV function recovery (regional Deltawall motion score -1.67+/-0.53 vs. -1.02+/-0.46, p=0.003; -1.42+/-0.58 vs. -1.02+/-0.46, p=0.03) than those of conservative therapy group. MCE and LDDSE showed good concordance for predicting LV functional recovery (kappa=0.63, p<0.001). Perfusion score index had a good correlation with LV functional recovery (r=-0.75, p<0.001).
  
  
  CONCLUSIONS
  This study demonstrates that perfusion score index obtained from real-time MCE is comparable to LDDSE in predicting the LV functional recovery even under different therapeutic interventions. Revascularization results in better preservation of myocardial microvascular integrity, regional contractile reserve and LV functional recovery.
authors.affiliation: Division of Cardiology, Kaohsiung Veterans General Hospital, No.386, Dar-Chung First Road, Kaohsiung City, Taiwan, ROC.
authors.forename: Wei-Chun
authors.initials: WC
authors.lastname: Huang
authors.forename: Kuan-Rau
authors.initials: KR
authors.lastname: Chiou
authors.forename: Chun-Peng
authors.initials: CP
authors.lastname: Liu
authors.forename: Shoa-Lin
authors.initials: SL
authors.lastname: Lin
authors.forename: Doyal
authors.initials: D
authors.lastname: Lee
authors.forename: Guang-Yuan
authors.initials: GY
authors.lastname: Mar
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Hsiao
authors.forename: Ming-Ho
authors.initials: MH
authors.lastname: Kung
authors.forename: Chuen-Wang
authors.initials: CW
authors.lastname: Chiou
authors.forename: Tzu-Wen
authors.initials: TW
authors.lastname: Lin
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000503:physiopathology / Q000628:therapy; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy*; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D015912:Thrombolytic Therapy; D016277:Ventricular Function, Left / Q000187:drug effects*