Knowledge of Perfusion and Contractile Reserve Improves the Predictive Value of Recovery of Regional Myocardial Function Postrevascularization
Autor: | Mario F. Meza, Stephen R. Ramee, Tyrone J. Collins, Dwight D. Stapleton, Joseph P. Murgo, Richard V. Milani, Jorge Cheirif |
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Rok vydání: | 1997 |
Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Contrast Media Infarction Revascularization Coronary artery disease Coronary artery bypass surgery Predictive Value of Tests Coronary Circulation Dobutamine Physiology (medical) Internal medicine Angioplasty Humans Medicine Postoperative Period Angioplasty Balloon Coronary Coronary Artery Bypass Aged Aged 80 and over Meglumine business.industry Heart Middle Aged medicine.disease Myocardial Contraction Echocardiography Predictive value of tests Cardiology Female Cardiology and Cardiovascular Medicine business Follow-Up Studies medicine.drug |
Zdroj: | Circulation. 96:3459-3465 |
ISSN: | 1524-4539 0009-7322 |
Popis: | Background This study was designed to determine the value of myocardial contrast echocardiography (MCE) and dobutamine echocardiography (DE), alone or in combination, in predicting functional recovery in patients with resting wall motion abnormalities due to CAD. MCE and DE have been independently shown to be useful in detecting myocardial viability in the post–myocardial infarction setting. Methods and Results Thirty-nine patients with significant coronary artery disease and resting wall motion abnormalities underwent DE (2.5 to 20 μg · kg −1 · min −1 ) and wall motion analysis (16-segment model). MCE was performed with selective intracoronary injections of sonicated meglumine (2 cm 3 ). Myocardial viability was defined as presence of contrast effect by MCE and contractile reserve or an ischemic response by DE. Functional recovery (improvement in wall motion) was assessed after revascularization (percutaneous transluminal coronary angioplasty, n=20; coronary artery bypass surgery, n=19). When the two groups of patients were analyzed, MCE was associated with excellent sensitivities (84%) yet poor specificities (19% to 26%); DE had lower sensitivities (79% to 80%) but also poor specificities (30% to 36%). The combination of both was associated with excellent sensitivities (90% to 93%) and modest specificities (48% to 50%) for predicting functional recovery. A biphasic response with DE was infrequent (14% to 42%) but highly specific of functional recovery (84% to 94%). MCE had an excellent negative predictive value for functional recovery (83%). Conclusions The prediction of functional recovery post-revascularization can be enhanced by combining MCE and DE. |
Databáze: | OpenAIRE |
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