Changes in the Doppler myocardial performance index during dobutamine echocardiography: association with neurohormonal activation and prognosis after acute myocardial infarction.
OBJECTIVE
To test whether an increase in Doppler myocardial performance index (MPI) during dobutamine stress echocardiography, reflecting deterioration of overall left ventricular function, is associated with increased N-terminal pro-brain natriuretic peptide (NT-pro-BNP) concentration and provides prognostic information beyond conventional systolic wall motion analysis after acute myocardial infarction (AMI).


METHODS
Prospective, observational study.


METHODS
Dobutamine-atropine stress echocardiography (DASE) and NT-pro-BNP were assessed five days after AMI in 109 consecutive patients. MPI was measured at rest and at low-dose (10 microg/kg/min) and peak dobutamine infusion (<or= 40 microg/kg/min with or without atropine).


METHODS
End point was a composite of cardiac death or readmission for heart failure or reinfarction.


RESULTS
In 35 patients (32%), MPI increased at low-dose DASE. This was associated with higher NT-pro-BNP concentrations (beta = 0.30, p = 0.004). During a mean follow up of 27 (SD 7) months, 8 patients died of cardiac causes and 15 patients were readmitted for heart failure or reinfarction. On Cox regression analysis, an increase in MPI at low-dose DASE (p = 0.02) was an independent predictor of cardiac events. In contrast, traditional wall motion analysis during DASE provided no additional prognostic information.


CONCLUSIONS
An increase in MPI at low-dose DASE, reflecting early deterioration of overall left ventricular function, is associated with raised NT-pro-BNP concentration and provides prognostic information beyond conventional stress echocardiographic data after AMI.
Nørager
B
B
Department of Medical Research, Svendborg Hospital, Svendborg, Denmark. bnorager@mail.dk
Husic
M
M
Møller
J E
JE
Bo Hansen
A
A
Pellikka
P A
PA
Egstrup
K
K
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D001285:Atropine / Q000008:administration & dosage; D002316:Cardiotonic Agents / Q000008:administration & dosage; D004280:Dobutamine / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004338:Drug Combinations; D015150:Echocardiography, Doppler / Q000379:methods; D025401:Echocardiography, Stress / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000503:physiopathology*; D020097:Natriuretic Peptide, Brain / Q000378:metabolism*; D015588:Observer Variation; D010446:Peptide Fragments / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies; D016019:Survival Analysis; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000503:physiopathology
D000889:Anti-Arrhythmia Agents; D002316:Cardiotonic Agents; D004338:Drug Combinations; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D004280:Dobutamine; D001285:Atropine