Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolytic therapy: comparison with positron emission tomography
LA Pierard,
CM De Landsheere,
C Berthe,
P Rigo,
and
HE Kulbertus
Department of Medicine, University of Liege, Belgium.
To assess the presence of viable myocardium salvaged by coronary artery reperfusion, 17 patients with acute anterior myocardial infarction were studied. Each received intravenous thrombolysis within the first 3 h of symptoms and underwent two-dimensional echocardiography before and during dobutamine infusion (10 micrograms/kg per min) 7 +/- 4 days after admission and positron emission tomography 9 +/- 5 days after admission. Echocardiography and positron emission tomography were again performed 9 +/- 7 months later. Six comparable segments specific for the territory of the left anterior descending artery were selected for comparison of the two techniques. Wall thickening was evaluated by using an echocardiographic score index. Segmental perfusion and glucose uptake were measured and normalized to the peak activity. A ratio of glucose uptake to perfusion was calculated for each segment. Concordant interpretation of the two techniques was found in 79% of affected segments for both acute and follow-up studies. Positron emission tomography revealed the presence of viable myocardium in 11 patients (group 1); perfusion was within normal limits in 5 of these (group 1A). Myocardial thickening improved with dobutamine infusion in these five patients, the echocardiographic score index decreasing from 12 +/- 2 at rest to 7.8 +/- 1.3 during dobutamine infusion (p = 0.003). Functional recovery was demonstrated in all five patients (follow-up score index 7.4 +/- 1.7). Six patients exhibited decreased perfusion but an abnormally high glucose to perfusion ratio (group 1B); their score index improved with dobutamine from 14.8 +/- 2.2 to 12 +/- 2.1 (p = 0.05), but late functional recovery was found in only one of the six patients (mean follow-up score index in group 1B 16 +/- 1.7). In the six remaining patients in whom no viable myocardium was detected with positron emission tomography (group 2), the echocardiographic score index did not change with dobutamine (15 +/- 0.9 to 14.7 +/- 0.8, p = NS) and there was no functional recovery (follow-up score index 15.5 +/- 1.0). Echocardiography during dobutamine infusion is a promising method to unmask viable myocardium in acute myocardial infarction. Early recovery of perfusion in the area at risk is associated with a good functional outcome, whereas a high glucose to perfusion ratio indicates jeopardized myocardium that frequently loses viability.
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D. J Duncker, R. Schulz, R. Ferrari, D. Garcia-Dorado, C. Guarnieri, G. Heusch, and P. D Verdouw
"Myocardial stunning": remaining questions
Cardiovasc Res,
June 1, 1998;
38(3):
549 - 558.
[Full Text]
[PDF]
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R. Belardinelli, D. Georgiou, L. Ginzton, G. Cianci, and A. Purcaro
Effects of Moderate Exercise Training on Thallium Uptake and Contractile Response to Low-Dose Dobutamine of Dysfunctional Myocardium in Patients With Ischemic Cardiomyopathy
Circulation,
February 17, 1998;
97(6):
553 - 561.
[Abstract]
[Full Text]
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M. F. Meza, S. Ramee, T. Collins, D. Stapleton, R. V. Milani, J. P. Murgo, and J. Cheirif
Knowledge of Perfusion and Contractile Reserve Improves the Predictive Value of Recovery of Regional Myocardial Function Postrevascularization : A Study Using the Combination of Myocardial Contrast Echocardiography and Dobutamine Echocardiography
Circulation,
November 18, 1997;
96(10):
3459 - 3465.
[Abstract]
[Full Text]
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Z.-X. He, R. Medrano, J. T. Hays, J. J. Mahmarian, and M. S. Verani
Nitroglycerin-Augmented 201Tl Reinjection Enhances Detection of Reversible Myocardial Hypoperfusion : A Randomized, Double-Blind, Parallel, Placebo-Controlled Trial
Circulation,
April 1, 1997;
95(7):
1799 - 1805.
[Abstract]
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J.-L. J. Vanoverschelde, W. Wijns, M. Borgers, G. Heyndrickx, C. Depre, W. Flameng, and J. A. Melin
Chronic Myocardial Hibernation in Humans: From Bedside to Bench
Circulation,
April 1, 1997;
95(7):
1961 - 1971.
[Full Text]
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M. A. Quinones
Risk Stratification After Myocardial Infarction: Clinical Science Versus Practice Behavior
Circulation,
March 18, 1997;
95(6):
1352 - 1354.
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S. C. Smart, T. Knickelbine, T. R. Stoiber, M. Carlos, J. C. Wynsen, and K. B. Sagar
Safety and Accuracy of Dobutamine-Atropine Stress Echocardiography for the Detection of Residual Stenosis of the Infarct-Related Artery and Multivessel Disease During the First Week After Acute Myocardial Infarction
Circulation,
March 18, 1997;
95(6):
1394 - 1401.
[Abstract]
[Full Text]
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M. E. Carlos, S. C. Smart, J. C. Wynsen, and K. B. Sagar
Dobutamine Stress Echocardiography for Risk Stratification After Myocardial Infarction
Circulation,
March 18, 1997;
95(6):
1402 - 1410.
[Abstract]
[Full Text]
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M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al.
ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography
Circulation,
March 18, 1997;
95(6):
1686 - 1744.
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A. Kranidis, T. Bouki, K. Kostopoulos, P. Anthopoulos, K. Kappos, J. Antonellis, M. Bonou, A. Sideris, D. Ralli, A. Tavernarakis, et al.
Stress Echocardiography Using Adenosine Combined with Nitroglycerin- Dobutamine in the Detection of Viable Myocardium in Patients with Previous Myocardial Infarction
Angiology,
February 1, 1997;
48(2):
127 - 133.
[Abstract]
[PDF]
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S. H. Rahimtoola
Hibernating Myocardium Has Reduced Blood Flow at Rest That Increases With Low-Dose Dobutamine
Circulation,
December 15, 1996;
94(12):
3055 - 3061.
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K. T. Sun, J. Czernin, J. Krivokapich, Y.-K. Lau, M. Bottcher, G. Maurer, M. E. Phelps, and H. R. Schelbert
Effects of Dobutamine Stimulation on Myocardial Blood Flow, Glucose Metabolism, and Wall Motion in Normal and Dysfunctional Myocardium
Circulation,
December 15, 1996;
94(12):
3146 - 3154.
[Abstract]
[Full Text]
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J. Sklenar, G. Camarano, N. C. Goodman, S. Ismail, A. R. Jayaweera, and S. Kaul
Contractile Versus Microvascular Reserve for the Determination of the Extent of Myocardial Salvage After Reperfusion: The Effect of Residual Coronary Stenosis
Circulation,
September 15, 1996;
94(6):
1430 - 1440.
[Abstract]
[Full Text]
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D. Pontillo, G. P. Carboni, A. Capezzuto, C. Alessi, A. Achilli, F. Piccini, and R. Guerra
Identification of Viable Myocardium by Nitrate Echocardiography After Myocardial Infarction: Comparison with Planar Thallium Reinjection Scintigraphy
Angiology,
May 1, 1996;
47(5):
437 - 446.
[Abstract]
[PDF]
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J.-L. J. Vanoverschelde, B. L. Gerber, A.-M. D'Hondt, M. De Kock, R. Dion, W. Wijns, and J. A. Melin
Preoperative Selection of Patients With Severely Impaired Left Ventricular Function for Coronary Revascularization : Role of Low-Dose Dobutamine Echocardiography and Exercise-Redistribution-Reinjection Thallium SPECT
Circulation,
November 1, 1995;
92(9):
37 - 44.
[Abstract]
[Full Text]
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A. Maes, F. Van de Werf, J. Nuyts, G. Bormans, W. Desmet, and L. Mortelmans
Impaired Myocardial Tissue Perfusion Early After Successful Thrombolysis : Impact on Myocardial Flow, Metabolism, and Function at Late Follow-up
Circulation,
October 15, 1995;
92(8):
2072 - 2078.
[Abstract]
[Full Text]
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C. Chen, L. Li, L. L. Chen, J. V. Prada, M. H. Chen, J. T. Fallon, A. E. Weyman, D. Waters, and L. Gillam
Incremental Doses of Dobutamine Induce a Biphasic Response in Dysfunctional Left Ventricular Regions Subtending Coronary Stenoses
Circulation,
August 15, 1995;
92(4):
756 - 766.
[Abstract]
[Full Text]
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V. Sansoy, D. K. Glover, D. D. Watson, M. Ruiz, W. H. Smith, J. P. Simanis, and G. A. Beller
Comparison of Thallium-201 Resting Redistribution With Technetium-99m–Sestamibi Uptake and Functional Response to Dobutamine for Assessment of Myocardial Viability
Circulation,
August 15, 1995;
92(4):
994 - 1004.
[Abstract]
[Full Text]
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M. Arnese, J. H. Cornel, A. Salustri, A. P.W.M. Maat, A. Elhendy, A. E.M. Reijs, F. J. Ten Cate, D. Keane, A. H.M.M. Balk, J. R.T.C. Roelandt, et al.
Prediction of Improvement of Regional Left Ventricular Function After Surgical Revascularization : A Comparison of Low-Dose Dobutamine Echocardiography With 201Tl Single-Photon Emission Computed Tomography
Circulation,
June 1, 1995;
91(11):
2748 - 2752.
[Abstract]
[Full Text]
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P. Perrone-Filardi, L. Pace, M. Prastaro, F. Piscione, S. Betocchi, F. Squame, P. Vezzuto, A. Soricelli, C. Indolfi, M. Salvatore, et al.
Dobutamine Echocardiography Predicts Improvement of Hypoperfused Dysfunctional Myocardium After Revascularization in Patients With Coronary Artery Disease
Circulation,
May 15, 1995;
91(10):
2556 - 2565.
[Abstract]
[Full Text]
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N. Tamaki, M. Kawamoto, E. Tadamura, Y. Magata, Y. Yonekura, R. Nohara, S. Sasayama, K. Nishimura, T. Ban, and J. Konishi
Prediction of ReversibleIschemia After Revascularization : Perfusion and Metabolic Studies WithPositron Emission Tomography
Circulation,
March 15, 1995;
91(6):
1697 - 1705.
[Abstract]
[Full Text]
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F. M. Baer, E. Voth, C. A. Schneider, P. Theissen, H. Schicha, and U. Sechtem
Comparison of Low-Dose Dobutamine–Gradient-Echo Magnetic Resonance Imaging and Positron Emission Tomography With [18F]Fluorodeoxyglucose in Patients With Chronic Coronary Artery Disease : A Functional and Morphological Approach to the Detection of Residual Myocardial Viability
Circulation,
February 15, 1995;
91(4):
1006 - 1015.
[Abstract]
[Full Text]
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I. Afridi, N. S. Kleiman, A. E. Raizner, and W. A. Zoghbi
Dobutamine Echocardiography in Myocardial Hibernation : Optimal Dose and Accuracy in Predicting Recovery of Ventricular Function After Coronary Angioplasty
Circulation,
February 1, 1995;
91(3):
663 - 670.
[Abstract]
[Full Text]
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E. C. Madu, W. Ahmar, J. Arthur, and T. D. Fraker Jr
Clinical Utility of Digital Dobutamine Stress Echocardiography in the Noninvasive Evaluation of Coronary Artery Disease
Arch Intern Med,
May 23, 1994;
154(10):
1065 - 1072.
[Abstract]
[PDF]
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