Myocardial Contrast Echocardiography Versus Dobutamine Echocardiography for Predicting Functional Recovery After Acute Myocardial Infarction Treated With Primary Coronary Angioplasty
| Autor: | Daniele Rovai, Leonardo Bolognese, Cecilia Marini, Giovanni M. Santoro, David Antoniucci, Antonio L'Abbate, Piergiovanni Buonamici, Pier Filippo Fazzini, Giampaolo Cerisano |
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| Rok vydání: | 1996 |
| Předmět: |
Adult
Male medicine.medical_specialty Cardiotonic Agents medicine.medical_treatment Myocardial Infarction Contrast Media Infarction Sensitivity and Specificity Ventricular Function Left Electrocardiography Coronary circulation Restenosis Predictive Value of Tests Coronary Circulation Dobutamine Angioplasty Internal medicine medicine Humans Prospective Studies Myocardial infarction Angioplasty Balloon Coronary Aged Aged 80 and over Ejection fraction medicine.diagnostic_test business.industry Reproducibility of Results Stroke Volume Middle Aged medicine.disease Myocardial Contraction Iopamidol medicine.anatomical_structure Echocardiography Cardiology Female Cardiology and Cardiovascular Medicine business medicine.drug |
| Zdroj: | Journal of the American College of Cardiology. 28:1677-1683 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/s0735-1097(96)00400-7 |
| Popis: | ObjectivesWe sought to compare myocardial contrast echocardiography with low dose dobutamine echocardiography for predicting 1-month recovery of ventricular function in acute myocardial infarction treated with primary coronary angioplasty.BackgroundThe relation between myocardial perfusion and contractile reserve in patients with acute myocardial infarction, in whom anterograde flow is fully restored without significant residual stenosis, is still unclear.MethodsThirty patients with acute myocardial infarction treated successfully with primary coronary angioplasty underwent intracoronary contrast echocardiography before and after angioplasty and dobutamine echocardiography 3 days after the index infarction. One month later, two-dimensional echocardiography and coronary angiography were repeated in all patients and contrast echocardiography in 18 patients.ResultsAfter coronary recanalization, 26 patients showed myocardial reperfusion within the risk area, although 4 did not. At 1-month follow-up, all patients had a patent infarct-related artery without significant restenosis. Both left ventricular ejection fraction and wall motion score index within the risk area significantly improved in the patients with reperfusion ([mean ± SD] 38 ± 8% vs. 48 ± 12%, p < 0.005; and 2.35 ± 0.5 vs. 2 ± 0.6, p < 0.001, respectively), but not in those with no reflow. Of the 72 nonperfused segments before angioplasty, 27 showed functional improvement at follow-up. Myocardial contrast echocardiography had a sensitivity and a negative predictive value similar to dobutamine echocardiography in predicting late functional recovery (96% vs. 89% and 89% vs. 93%, respectively), but a lower specificity (18% vs. 91%, p < 0.001), positive predictive value (41% vs. 86%, p < 0.001) and overall accuracy (47% vs. 90%, p < 0.001).ConclusionsMicrovascular integrity is a prerequisite for myocardial viability after acute myocardial infarction. However, contrast enhancement shortly after recanalization does not necessarily imply a late functional improvement. Thus, contractile reserve elicited by low dose dobutamine is a more accurate predictor of regional functional recovery after reperfused acute myocardial infarction than microvascular integrity. |
| Databáze: | OpenAIRE |
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