|
|
||||||||||
|
J Am Coll Cardiol, 1998; 31:1002-1010 © 1998 by the American College of Cardiology Foundation |
Department of Cardiology, Medical Center Alkmaar, The Netherlands. jcornel@mca.alkmaar.nl
OBJECTIVES: This study sought to evaluate the time course of improvement of left ventricular (LV) dysfunction in stable patients and its implications on the accuracy of dobutamine echocardiography for predicting improvement after surgical revascularization. BACKGROUND: Little is known about the optimal timing for evaluation of postrevascularization recovery of the contractile function of viable myocardium. METHODS: Sixty-one patients with chronic ischemic LV dysfunction scheduled for elective surgical revascularization were prospectively selected. They underwent dobutamine echocardiography (5 to 40 microg/kg body weight per min) and radionuclide ventriculography both preoperatively and at 3-month follow-up. At 14 months, another evaluation of LV function was obtained. To analyze echocardiograms, a 16-segment model and a five-point scoring system were used. Dyssynergic segments were considered likely to recover in the presence of a biphasic contractile response to dobutamine. Improvement of global function was defined as a > or =5% increase in LV ejection fraction (LVEF). RESULTS: Of the 61 patients, LVEF improved in 12 at 3 months and in 19 at late follow-up (from 32+/-8% to 42+/-9%, p < 0.0001). The frequency and time course of improvement of LVEF were similar in patients with mild and severe LV dysfunction. A biphasic response, identified in 186 of the 537 dyssynergic segments, was predictive of recovery in 63% at 3 months and in 75% at late follow-up. The positive predictive value was best in the most severe dyssynergic segments (90% vs. 67%). Other responses were highly predictive for nonrecovery (92%). The sensitivity and specificity for improvement of global function on a patient basis (> or =4 biphasic segments) were 89% and 81%, respectively, at late follow-up. CONCLUSIONS: Serial postoperative follow-up studies demonstrate incomplete recovery of contractile function at 3 months. The diagnostic accuracy of dobutamine echocardiography for predicting recovery is dependent on three factors: the combining of low and high dobutamine dosages, the severity of regional dyssynergy and the timing of evaluation.
This article has been cited by other articles:
![]() |
P. G. Camici, S. K. Prasad, and O. E. Rimoldi Stunning, Hibernation, and Assessment of Myocardial Viability Circulation, January 1, 2008; 117(1): 103 - 114. [Full Text] [PDF] |
||||
![]() |
M. D. Banas, S. Baldwa, G. Suzuki, J. M. Canty Jr., and J. A. Fallavollita Determinants of contractile reserve in viable, chronically dysfunctional myocardium Am J Physiol Heart Circ Physiol, June 1, 2007; 292(6): H2791 - H2797. [Abstract] [Full Text] [PDF] |
||||
![]() |
V. Bodi, J. Sanchis, M. P. Lopez-Lereu, A. Losada, J. Nunez, M. Pellicer, V. Bertomeu, F. J. Chorro, and A. Llacer Usefulness of a Comprehensive Cardiovascular Magnetic Resonance Imaging Assessment for Predicting Recovery of Left Ventricular Wall Motion in the Setting of Myocardial Stunning J. Am. Coll. Cardiol., November 1, 2005; 46(9): 1747 - 1752. [Abstract] [Full Text] [PDF] |
||||
![]() |
L A Pierard and P Lancellotti Determinants of persistent negative T waves and early versus late T wave normalisation after acute myocardial infarction Heart, August 1, 2005; 91(8): 1008 - 1012. [Abstract] [Full Text] [PDF] |
||||
![]() |
V Rizzello, D Poldermans, E Biagini, A F L Schinkel, R van Domburg, A Elhendy, E C Vourvouri, M Bountioukos, A Lombardo, B Krenning, et al. Improvement of stress LVEF rather than rest LVEF after coronary revascularisation in patients with ischaemic cardiomyopathy and viable myocardium Heart, March 1, 2005; 91(3): 319 - 323. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. M. Leung, W. H. Bellows, and D. Pastor Does Intraoperative Evaluation of Left Ventricular Contractile Reserve Predict Myocardial Viability? A Clinical Study Using Dobutamine Stress Echocardiography in Patients Undergoing Coronary Artery Bypass Graft Surgery Anesth. Analg., September 1, 2004; 99(3): 647 - 654. [Abstract] [Full Text] [PDF] |
||||
![]() |
S.R. Underwood, J. J Bax, J. v. Dahl, M. Y Henein, A. C van Rossum, E. R Schwarz, J.-L. Vanoverschelde, E. E.v. d. Wall, and W. Wijns Imaging techniques for the assessment of myocardial hibernation: Report of a Study Group of the European Society of Cardiology Eur. Heart J., May 2, 2004; 25(10): 815 - 836. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. J. Eichhorn, P. A. Grayburn, S. A. Mayer, M. St John Sutton, C. Appleton, J. Plehn, J. Oh, B. Greenberg, A. DeMaria, R. Frantz, et al. Myocardial Contractile Reserve by Dobutamine Stress Echocardiography Predicts Improvement in Ejection Fraction With {beta}-Blockade in Patients With Heart Failure: The {beta}-Blocker Evaluation of Survival Trial (BEST) Circulation, November 11, 2003; 108(19): 2336 - 2341. [Abstract] [Full Text] [PDF] |
||||
![]() |
M Bountioukos, A F L Schinkel, J J Bax, V Rizzello, R Rambaldi, E C Vourvouri, J R T C Roelandt, and D Poldermans Quantification of regional left ventricular function in Q wave and non-Q wave dysfunctional regions by tissue Doppler imaging in patients with ischaemic cardiomyopathy Heart, November 1, 2003; 89(11): 1322 - 1326. [Abstract] [Full Text] [PDF] |
||||
![]() |
P. Lancellotti, E. P. Hoffer, and L. A. Pierard Detection and clinical usefulness of a biphasic response during exercise echocardiography early after myocardial infarction J. Am. Coll. Cardiol., April 2, 2003; 41(7): 1142 - 1147. [Abstract] [Full Text] [PDF] |
||||
![]() |
C. A. Visser and F. Nijland Current Status of Echocardiography for Detection of Myocardial Ischemia and Viability Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2003; 7(1): 41 - 43. [PDF] |
||||
![]() |
T. H Marwick Stress echocardiography Heart, January 1, 2003; 89(1): 113 - 118. [Full Text] [PDF] |
||||
![]() |
F Nijland, O Kamp, P M J Verhorst, W G de Voogt, and C A Visser Early prediction of improvement in ejection fraction after acute myocardial infarction using low dose dobutamine echocardiography Heart, December 1, 2002; 88(6): 592 - 596. [Abstract] [Full Text] [PDF] |
||||
![]() |
T Zaglavara, R Haaverstad, B Cumberledge, T Irvine, H Karvounis, G Parharidis, G Louridas, and A Kenny Dobutamine stress echocardiography for the detection of myocardial viability in patients with left ventricular dysfunction taking {beta} blockers: accuracy and optimal dose Heart, April 1, 2002; 87(4): 329 - 335. [Abstract] [Full Text] [PDF] |
||||
![]() |
F B Sozzi, D Poldermans, J J Bax, A Elhendy, E C Vourvouri, R Valkema, J De Sutter, A F L Schinkel, A Borghetti, and J R T C Roelandt Improved identification of viable myocardium using second harmonic imaging during dobutamine stress echocardiography Heart, December 1, 2001; 86(6): 672 - 678. [Abstract] [Full Text] [PDF] |
||||
![]() |
F Piscione, P Perrone-Filardi, G De Luca, M Prastaro, C Indolfi, P Golino, S Dellegrottaglie, and M Chiariello Low dose dobutamine echocardiography for predicting functional recovery after coronary revascularisation Heart, December 1, 2001; 86(6): 679 - 686. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. J. Bax, F. C. Visser, D. Poldermans, A. Elhendy, J. H. Cornel, E. Boersma, A. van Lingen, P. M. Fioretti, and C. A. Visser Time Course of Functional Recovery of Stunned and Hibernating Segments After Surgical Revascularization Circulation, September 18, 2001; 104(90001): I-314 - 318. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. J. Bax, F. C. Visser, D. Poldermans, A. Elhendy, J. H. Cornel, E. Boersma, R. Valkema, A. van Lingen, P. M. Fioretti, and C. A. Visser Relationship Between Preoperative Viability and Postoperative Improvement in LVEF and Heart Failure Symptoms J. Nucl. Med., January 1, 2001; 42(1): 79 - 86. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Pasquet, M.S. Lauer, M.J. Williams, M.-A. Secknus, B. Lytle, and T.H. Marwick Prediction of global left ventricular function after bypass surgery in patients with severe left ventricular dysfunction. Impact of pre-operative myocardial function, perfusion, and metabolism Eur. Heart J., January 2, 2000; 21(2): 125 - 136. [Abstract] [PDF] |
||||
![]() |
R J Trent, G D Waiter, G S Hillis, F I McKiddie, T W Redpath, and S Walton Dobutamine magnetic resonance imaging as a predictor of myocardial functional recovery after revascularisation Heart, January 1, 2000; 83(1): 40 - 46. [Abstract] [Full Text] [PDF] |
||||
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |