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CLINICAL STUDIES

Prediction of functional recovery of viable myocardium after delayed revascularization in postinfarction patients

Accuracy of dobutamine stress echocardiography and influence of long-term vessel patency

Jean-Luc Monin, MD^*, J.érôme Garot, MD^*, Marielle Scherrer-Crosbie, MD^*, Jean Rosso, MD^*, Anne-Marie Duval-Moulin, MD^*, Patrick Dupouy, MD, Emmanuel Teiger, MD, Alain Castaigne, MD^*, Jean-Claude Cachin, MD^*, Jean-Luc Dubois-Rande, MD, PhD^* and Pascal Gueret, MD, FACC^*

^* Fédération de Cardiologie, Hôpital Henri Mondor, 51 Avenue Maréchal De Lattre de Tassigny, 94010, Créteil, France
Service des Explorations Fonctionnelles, Hôpital Henri Mondor, AP-HP, 51 Avenue Maréchal De Lattre de Tassigny, 94010, Créteil, France

Manuscript received May 26, 1998; revised manuscript received April 16, 1999, accepted June 10, 1999.

Reprint requests and correspondence: Dr. J. L. Monin, Fédération de Cardiologie, Hôpital Henri Mondor, 51 av. Maréchal De Lattre de Tassigny, 94010 Créteil, France
pascal.gueret{at}hmn.ap.hop.paris.fr

OBJECTIVES

We sought to evaluate Dobutamine stress echocardiography (DSE) for predicting recovery of viable myocardium after revascularization with cineangiography as a gold standard for left ventricular (LV) function. We studied the influence of late vessel reocclusion on regional LV function.

BACKGROUND

Dobutamine stress echocardiography is a well established evaluation method for myocardial viability assessment. In previous studies the reference method for assessing LV recovery was echocardiography; long-term vessel patency has not been systematically addressed.

METHODS

Sixty-eight patients with a first acute myocardial infarction (AMI) and residual stenosis of the infarct related artery (IRA) underwent DSE (mean ± standard deviation) 21 ± 12 days after AMI to evaluate myocardial viability. Revascularization of the IRA was performed in 54 patients by angioplasty (n = 43) or bypass grafting (n = 11). Coronary angiography and LV cineangiography were repeated at four months to assess LV function and IRA patency.

RESULTS

Sensitivity and specificity of DSE for predicting myocardial recovery after revascularization were 83% and 82%. In the case of late IRA patency, specificity increased to 95%, whereas sensitivity remained unchanged. In the 16 patients with myocardial viability and late IRA patency, echocardiographic wall motion score index decreased after revascularization from 1.83 ± 0.15 to 1.36 ± 0.17 (p = 0.0001), and left ventricular ejection fraction (LVEF) increased from 0.52 ± 0.06 to 0.57 ± 0.06 (p = 0.0004), whereas in five patients, reocclusion of the IRA prevented improvement of segmental or global LV function despite initially viable myocardium.

CONCLUSIONS

Dobutamine stress echocardiography is reliable to predict recovery of viable myocardium after revascularization in postinfarction patients. Late reocclusion of the IRA may prevent LV recovery and influence the accuracy of DSE.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   AMI = acute myocardial infarction   ANOVA = two-way analysis of variance   BP = blood pressure   CABG = coronary artery bypass grafting   CAD = coronary artery disease   DSE = dobutamine stress echocardiography   ECG = electrocardiogram   IRA = infarct-related artery   LAD = left anterior descending   LV = left ventricle or ventricular   LVEF = left ventricular ejection fraction   PTCA = percutaneous transluminal coronary angioplasty   SD = standard deviation   WMSI = wall motion score index

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