title: Changes in the Doppler myocardial performance index during dobutamine echocardiography: association with neurohormonal activation and prognosis after acute myocardial infarction.
abstract: 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.
authors.affiliation: Department of Medical Research, Svendborg Hospital, Svendborg, Denmark. bnorager@mail.dk
authors.forename: B
authors.initials: B
authors.lastname: Nørager
authors.forename: M
authors.initials: M
authors.lastname: Husic
authors.forename: J E
authors.initials: JE
authors.lastname: Møller
authors.forename: A
authors.initials: A
authors.lastname: Bo Hansen
authors.forename: P A
authors.initials: PA
authors.lastname: Pellikka
authors.forename: K
authors.initials: K
authors.lastname: Egstrup
mesh_terms: 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
chemical_list: 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