title: Predischarge low-dose dobutamine test and prediction of left ventricular function at 1 year in patients with a first anterior myocardial infarction.
abstract: BACKGROUND
  It is unclear whether spontaneous improvement in contractility following acute myocardial infarction (AMI) is related to severity of predischarge systolic dysfunction and can be predicted by isotopic ventriculography with a low-dose dobutamine test (DBT).
  
  
  OBJECTIVE
  Spontaneous improvement in contractility would be similar in patients with more preserved and those with depressed ventricular function, and a DBT test could predict it.
  
  
  METHODS
  Left ventricular ejection fraction (LVEF), regional contractility score (RCS), and left ventricular end-diastolic volume index (EDVI) at predischarge, during DBT, and at 1 year were analyzed in 43 patients with a first anterior ST-elevation AMI.
  
  
  RESULTS
  Changes produced by DBT in patients with LVEF < 40%, RCS > or = 3, or EDVI > or = 70 ml/m2 were smaller than in those observed at 1 year (LVEF: 30 +/- 5-35 +/- 7%, p < 0.001, vs. 39 +/- 10%, p = 0.005; RCS: 4.9 +/- 1.4-4.6 +/- 2.0, NS, vs. 3.4 +/- 2.0, p < 0.02; EDVI: 92 +/- 14-86 +/- 22, NS, vs. 78 +/- 23 ml/m2, p < 0.03). In contrast, in patients with EF > or = 40%, RCS < 3 or EDVI < 70 ml/m2, changes with DBT tended to be greater than those observed at 1 year (LVEF: 52 +/- 8-57 +/- 11%, p < 0.004 vs. 55 +/- 11%, p < 0.04); RCS: 1.1 +/- 0.9-0.8 +/- 0.8, NS, vs. 1.1 +/- 1.1, NS; and EDVI: 51 +/- 9-47 +/- 11, p < 0.005, vs. 54 +/- 13 ml/m2, NS).
  
  
  CONCLUSIONS
  Among patients with a first anterior AMI, spontaneous improvement in contractility at 1 year was greatest in those with a more depressed ventricular function or a dilated ventricle, but its magnitude was underestimated by a predischarge DBT test.
authors.affiliation: Unitat Coronària, Servei de Cardiologia, Hospital General Vall d'Hebron, P. Vall d'Hebron 119-129, 08035 Barcelona, Spain. 5751jfb@comb.es
authors.forename: Jaume
authors.initials: J
authors.lastname: Figueras
authors.forename: Josefa
authors.initials: J
authors.lastname: Cortadellas
authors.forename: Mario
authors.initials: M
authors.lastname: Missorici
authors.forename: Joan
authors.initials: J
authors.lastname: Castell
authors.forename: Jordi Soler
authors.initials: JS
authors.lastname: Soler
mesh_terms: D002316:Cardiotonic Agents; D017023:Coronary Angiography; D003971:Diastole; D004280:Dobutamine; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005544:Forecasting; D006334:Heart Function Tests; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D009203:Myocardial Infarction / Q000503:physiopathology*; D019275:Radiopharmaceuticals; D013318:Stroke Volume / Q000502:physiology*; D017256:Technetium Tc 99m Sestamibi; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D002316:Cardiotonic Agents; D019275:Radiopharmaceuticals; D004280:Dobutamine; D017256:Technetium Tc 99m Sestamibi