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CLINICAL STUDY

Detection and clinical usefulness of a biphasic response during exercise echocardiography early after myocardial infarction

^* Department of Cardiology, University Hospital, Liège, Belgium

Manuscript received July 16, 2002; revised manuscript received November 27, 2002, accepted December 12, 2002.

^* Reprint requests and correspondence: Dr. Luc A. Piérard, Department of Cardiology, University Hospital, 4000 Liege, Belgium.
lpierard{at}chu.ulg.ac.be

OBJECTIVES: The aim of this study was to determine the accuracy of exercise echocardiography (EE) for detecting infarct-related artery (IRA) stenosis and predicting functional recovery early after acute myocardial infarction (AMI).

BACKGROUND: Dobutamine stress echocardiography is widely used for identifying jeopardized myocardium. The clinical usefulness of a biphasic response detected during EE has never been investigated.

METHODS: A total of 114 consecutive patients with a first AMI and 2 dyssynergic segments in the infarct-related territory underwent semi-supine continuous EE 6 ± 2 days after AMI. Quantitative coronary angiography was performed in all patients after EE. A follow-up echocardiogram was obtained one month later.

RESULTS: Ninety-seven patients had significant (50%) IRA stenosis, and 26 had multivessel disease. Residual ischemia was identified in 77 patients (biphasic response in 62 and worsening response in 15). The sensitivity and specificity of ischemia during EE for predicting IRA stenosis were 75% and 76%, respectively. The sensitivity of a biphasic response was higher than the sensitivity of a worsening response (61% vs. 14%, p < 0.0001). Wall motion abnormalities induced in other vascular territories were specific (97%) and moderately sensitive (62%) for the detection of multivessel disease. Functional recovery was observed in 75 patients. Two independent variables predicted contractile recovery: contractile reserve during EE (p < 0.0001) and elective angioplasty of the IRA (p = 0.002). A biphasic response, but not sustained improvement, predicted reversible dysfunction (73% vs. 9%, p < 0.0001).

CONCLUSIONS: A biphasic response can be detected during exercise. Exercise echocardiography is an accurate tool for detecting IRA stenosis and predicting functional improvement early after AMI.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CK-MB = creatine kinase-MB fraction   ECG = electrocardiogram/electrocardiographic   EE = exercise echocardiography   IRA = infarct-related artery

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