Predictive significance of residual ischemia proved by dobutamine stress: Echocardiography test in patients early after the first uncomplicated myocardial infarction (original) (raw)
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Journal of The American College of Cardiology, 1997
Objectives. The aim of this multicenter, multinational, prospective, observational study was to assess the relative value of myocardial viability and induced ischemia early after uncomplicated myocardial infarction.Background. Dobutamine–atropine stress echocardiography allows evaluation of rest function (at baseline), myocardial viability (at low dose) and residual ischemia (peak dose, up to 40 μg with atropine up to 1 mg) in one test.Methods. Dobutamine–atropine stress echocardiography was performed 12 ± 5 days (mean ± SD) after a first uncomplicated acute myocardial infarction in 778 patients (677 men; mean age 58 ± 10 years) with technically satisfactory rest echocardiographic study results. Patients were followed-up for 9 ± 7 months.Results. Dobutamine–atropine stress echocardiographic findings were positive for myocardial ischemia in 436 of patients (56%) and negative in 342 (44%). During follow-up, there were 14 cardiac-related deaths (1.8% of the total cohort), 24 (2.9%) nonfatal myocardial infarctions and 63 (8%) hospital readmissions for unstable angina. One hundred seventy-four patients (22%) underwent coronary revascularization (bypass surgery or coronary angioplasty). Spontaneous events occurred in 61 of 436 patients with positive and 40 of 342 patients with negative findings on dobutamine–atropine stress echocardiography (14% vs. 12%, p = 0.3). When only spontaneously occurring events were considered, the most important predictor was myocardial viability (chi-square 9.7). Using the Cox proportional hazards model, only the presence of myocardial viability (hazard ratio [HR] 2.0, p < 0.002) and age (HR 1.03, p < 0.001) were predictive of spontaneously occurring events. When only hard cardiac events were considered, age was the strongest predictor (chi-square 3.6, p = 0.056), followed by wall motion score index (WMSI) at peak dose (chi-square 3.3, p = 0.06) and remote ischemia (chi-square 2.25, p = 0.1). When cardiac death was considered, WMSI at peak dose was the best predictor (HR 9.2, p < 0.0001).Conclusions. During dobutamine stress, echocardiographic recognition of myocardial viability is more prognostically important than echocardiographic recognition of myocardial ischemia for predicting unstable angina, whereas WMSI at peak stress was the best predictor of cardiac-related death. Different events can be recognized with different efficiency by various stress echocardiographic variables.(J Am Coll Cardiol 1997;29:254–60)
Heart, 2006
To establish further the role of dobutamine stress echocardiography (DSE) in prognostication of outcome early after acute myocardial infarction (AMI) Methods: Consecutive patients presenting with AMI were screened for inclusion into the study. 212 stable consenting patients underwent DSE a mean (SD) of 4.8 (1.5) days after AMI. Patients were then followed up for 803 (297) days. Results: The mean (SD) resting systolic wall thickening index (SWTI) was 1.6 (0.4), 44% patients had evidence of viability at low dose, and 38% had evidence of ischaemia. During the follow up period 27 (13%) patients died and 16 (8%) had a non-fatal AMI. Independent predictors of both mortality and combined mortality and non-fatal AMI were age (hazard ratio (HR) 1.04/year, p = 0.01, and HR 1.03/ year, p = 0.04, respectively) and SWTI at low dose (HR 3.6, p , 0.01, and HR 2.5, p = 0.02, respectively). Low dose DSE provided incremental information over clinical and resting left ventricular function data for predicting death and non-fatal AMI. For patients who were not revascularised SWTI at peak dose dobutamine was the only independent predictor of mortality. Conclusion: DSE is a powerful predictor of outcome in stable survivors of AMI. The presence of myocardial viability has a positive impact on survival.
Prognostic Value of 12-Lead Electrocardiogram During Dobutamine Stress Echocardiography
Echocardiography, 2000
The aim of this study was to assess the prognostic value of the 12-lead electrocardiogram (ECG) obtained during dobutamine stress echocardiography (DSE) in predicting subsequent cardiac events. We retrospectively analyzed 345 patients undergoing DSE in 1992-1994 and selected those patients with negative echo results for ischemia. Of the 200 patients with negative DSE results, a separate analysis of their ECG data was performed with results reported as either positive, negative, or nondiagnostic for ischemia. Follow-up was performed through a physician chart review and direct telephone contact. Event rates were determined for hard (myocardial infarction or cardiac death) and soft (hospitalization for angina andlor congestive heart failure, coronary angioplasty, or coronary artery bypass graft surgery) cardiac events occurring after the negative DSE for up to 6 years after the test. Death was also determined by referencing the patients' data with mortality data available on the Internet. There were 143 patients with ECG data reported as negative and 40 patients with ECG data reported as positive for ischemia. The hard and soft event rates were 1.5% and 9% per patient per year in the ECG negative group and 2% and 11% in the ECG positive group. There were no statistical differences in event rates between the two groups during the 5-year follow-up period. Our results suggest that the ECG result obtained during DSE does not confer any incremental prognostic value over the echo result.
The American Journal of Medicine, 1994
PURPOSE: To compare the relative value of clinical variables with dobutamine-atropine stress echocardiography to predict cardiac events during long-term follow-up. Dobutamine stress echocardiography is increasingly used for the detection of coronary artery disease, but little is known of its prognostic value. PATIENTS AND METHODS: A total of 430 patients (310 men; mean age 61 years, range 22 to 90) were enrolled in the study. Patients were referred for chest pain complaints and were unable to perform an adequate exercise stress test. All patients underwent dobutamine-atropine stress test (incremental dobutamine infusion: 10 to 40 pg/kg/minute, continued with atropine 0.25 to 1 mg intravenously if necessary to achieve 85% of the age predicted maximal heart rate, without symptoms or signs of ischemia) and clinical cardiac evaluation. Follow-up was 17 + 5 months, with a minimum of 6 months; 3 patients were lost to follow-up. Cardiac events were defined as cardiac death, nonfatal myocardial infarction, and coronary revascularization. RESULTS: Seventy-nine cardiac events occurred in 76 patients: cardiac death (n = ll), nonfatal myocardial infarction (n = 18), and coronary revascularization (n q 50). By multivariate regression analysis, the prognostic value of the stress test in addition to common clinical variables was assessed. (1) Cardiac death was predicted by age greater than 70 years (odds ratio 5.6, 1.5 to 20) or new wall motion abnormalities in a study that is normal at rest (odds ratio 4.1, 1.1 to 15). (2) Death or myocardial infarction was predicted by a history of myocardial infarction (odds ratio 4.8, 1.8 to 13) or age greater than 70 years (odds ratio 2.3, 1.1 to 5.4), and the stress test outcome provided no
International Journal of Research in Pharmaceutical Sciences, 2019
Background: Coronary artery disease (CAD) is a spectrum of heart diseases which has the highest mortality in the world. Dobutamine stress echocardiography (DSE) has emerged as a versatile and simple tool to assess myocardial function and has been used extensively to determine myocardial viability and predict reversibility of ischemia induced reduction in functional parameters. Aim of study: assess the function and viability of ischemic myocardium of left ventricle (LV) before and after percutaneous coronary intervention (PCI) by using low dose dobutamine stress echocardiography (LDDSE) and to know the usefulness of low dose dobutamine (LDD) test in detecting the viable ischemic LV area. Method: DSE was performed in 30 Iraqi patients (mean age 39-74 years; mean ejection fraction 45.8±7.96%) with previous myocardial infarction (MI) (ischemia before more than 30 days) who were referred to Ibn Al-Bitar Specialized Center for Cardiac Surgery in Iraq-Baghdad for evaluation of LV myocardial function and viability and possible need for coronary angiography Between October 2016 to June 2018. Visual assessment of the regional LV systolic function was performed at the time of examination using a 17-segment model of the LV. The scores of all segments are summed to obtain the LV wall motion score (WMS) which is divided by the number of scored segments to obtain a wall motion score index (WMSI). Viability was predicted by WMS if function augmented during LDDSE. Regional and global functional recovery was defined by side-by-side comparison of echocardiographic images before and (3-6) months after revascularization. Result: there was significant decrease in WMSI from (1.9±0.33) before dobutamine to (1.69±0.3) after dobutamine. Then there was a significant relative increase in WMSI from (1.69±0.30) after giving 5 g/kg/min dobutamine to (1.78±0.31) after giving 10 g/kg/min dobutamine (P value 0.003). While there were no significant differences in WMSI after low dose dobutamine (1.69±0.3) with the same parameters 3-6 months after PCI (1.64±0.38). Also there were significant improvements of LV function after doing PCI as assessed by WMSI and EF. Conclusion: WMSI during DSE is valuable tool to assess ischemic LV function and to evaluate its viability and predict of LV function improvement after doing PCI for the diseased artery.
The American Journal of Cardiology, 2005
We enrolled 196 patients who had myocardial infarction and no ischemia on dobutamine stress echocardiography (DSE) and/or single-photon emission computed tomography (SPECT). Negative studies were observed in 125 patients on DSE and in 159 on SPECT. Patients were followed for 43 ؎ 14 months. Cardiac events occurred in 14% of patients who did not have ischemia on DSE and in 9% of patients who did not have ischemia on SPECT. Event-free survival rate was higher in the presence of negative findings on SPECT compared with DSE (p <0.05). The lack of residual myocardial ischemia on SPECT identifies patients at low risk of events, and a negative finding on stress SPECT is superior to a negative finding on DSE. © 2005 Elsevier Inc. All rights reserved. (Am J Cardiol 2005;96:13-16)