Skip to main content
PMC home page
Heart logoLink to Heart
. 2000 Jan;83(1):35–39. doi: 10.1136/heart.83.1.35

The grade of worsening of regional function during dobutamine stress echocardiography predicts the extent of myocardial perfusion abnormalities

A Elhendy 1, R T van Domburg 1, J Bax 1, D Poldermans 1, P Nierop 1, M Geleijnse 1, J Roelandt 1
PMCID: PMC1729286  PMID: 10618333

Abstract

AIM—To evaluate the angiographic, myocardial perfusion, and wall motion abnormalities in patients with severe compared with mild worsening of regional function during dobutamine stress echocardiography (DSE) for evaluation of myocardial ischaemia.
METHODS—147 patients with significant coronary artery disease and new or worsening wall motion abnormalities during DSE were enrolled. Left ventricular function was evaluated using a 16 segment/4 grade score model where 1 = normal and 4 = dyskinesis. Simultaneous sestamibi SPECT myocardial perfusion imaging was performed in all patients.
RESULTS—Severe worsening of regional function (an increase in wall motion score of two grades or more in ⩾ 1 segment) was detected in 37 patients, while 110 patients had mild worsening (an increase in wall motion score of no more than one grade in ⩾ 1 segment). Patients with severe worsening of regional function had more stenotic coronary arteries (2.31 (0.8) v 1.97 (0.8) (mean (SD)) (p <0.05), a higher prevalence of left anterior descending coronary artery disease (95% v 73%) (p < 0.05), a higher resting wall motion score index (1.71 (0.42) v 1.51 (0.40) (p = 0.01), and more stress perfusion defects (3.8 (1.5) v 2.8 (1.5) (p < 0.001) compared with patients with mild worsening. Multivariate analysis identified the number of stress perfusion defects (p < 0.005, χ2 = 8.8) and the number of ischaemic segments on echocardiography (p < 0.05, χ2 = 4.3) as independent variables associated with severe worsening of regional function.
CONCLUSIONS—The grade of worsening of regional function during DSE predicts the underlying extent of myocardial perfusion abnormalities. The occurrence of severe worsening of regional function is associated with variables known to predict worse prognosis in patients with coronary artery disease.


Keywords: coronary artery disease; myocardial perfusion; ventricular function; echocardiography

Full Text

The Full Text of this article is available as a PDF (75.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Calnon D. A., Glover D. K., Beller G. A., Vanzetto G., Smith W. H., Watson D. D., Ruiz M. Effects of dobutamine stress on myocardial blood flow, 99mTc sestamibi uptake, and systolic wall thickening in the presence of coronary artery stenoses: implications for dobutamine stress testing. Circulation. 1997 Oct 7;96(7):2353–2360. doi: 10.1161/01.cir.96.7.2353. [DOI] [PubMed] [Google Scholar]
  2. Elhendy A., Cornel J. H., Roelandt J. R., van Domburg R. T., Nierop P. R., Geleÿnse M. L., El-Said G. M., Fioretti P. M. Relation between contractile response of akinetic segments during dobutamine stress echocardiography and myocardial ischemia assessed by simultaneous thallium-201 single-photon emission computed tomography. Am J Cardiol. 1996 May 1;77(11):955–959. doi: 10.1016/s0002-9149(96)00009-4. [DOI] [PubMed] [Google Scholar]
  3. Elhendy A., Geleijnse M. L., Roelandt J. R., van Domburg R. T., Cornel J. H., TenCate F. J., Postma-Tjoa J., Reijs A. E., el-Said G. M., Fioretti P. M. Evaluation by quantitative 99m-technetium MIBI SPECT and echocardiography of myocardial perfusion and wall motion abnormalities in patients with dobutamine-induced ST-segment elevation. Am J Cardiol. 1995 Sep 1;76(7):441–448. doi: 10.1016/s0002-9149(99)80127-1. [DOI] [PubMed] [Google Scholar]
  4. Elhendy A., Geleijnse M. L., Roelandt J. R., van Domburg R. T., Nierop P. R., Bax J. J., Kasprzak J. D., el-Said G. M., Ibrahim M. M., Fioretti P. M. Dobutamine 99Tcm-MIBI SPET myocardial perfusion scintigraphy in the prediction of restenosis after percutaneous transluminal coronary angioplasty in patients unable to perform an exercise stress test. Nucl Med Commun. 1997 Feb;18(2):122–128. doi: 10.1097/00006231-199702000-00006. [DOI] [PubMed] [Google Scholar]
  5. Elhendy A., van Domburg R. T., Roelandt J. R., Geleijnse M. L., Ibrahim M. M., Fioretti P. M. Safety and feasibility of dobutamine-atropine stress testing in hypertensive patients. Hypertension. 1997 Jun;29(6):1232–1239. doi: 10.1161/01.hyp.29.6.1232. [DOI] [PubMed] [Google Scholar]
  6. Geleijnse M. L., Elhendy A., van Domburg R. T., Cornel J. H., Rambaldi R., Salustri A., Reijs A. E., Roelandt J. R., Fioretti P. M. Cardiac imaging for risk stratification with dobutamine-atropine stress testing in patients with chest pain. Echocardiography, perfusion scintigraphy, or both? Circulation. 1997 Jul 1;96(1):137–147. doi: 10.1161/01.cir.96.1.137. [DOI] [PubMed] [Google Scholar]
  7. Geleijnse M. L., Fioretti P. M., Roelandt J. R. Methodology, feasibility, safety and diagnostic accuracy of dobutamine stress echocardiography. J Am Coll Cardiol. 1997 Sep;30(3):595–606. doi: 10.1016/s0735-1097(97)00206-4. [DOI] [PubMed] [Google Scholar]
  8. Klein L. W., Weintraub W. S., Agarwal J. B., Schneider R. M., Seelaus P. A., Katz R. I., Helfant R. H. Prognostic significance of severe narrowing of the proximal portion of the left anterior descending coronary artery. Am J Cardiol. 1986 Jul 1;58(1):42–46. doi: 10.1016/0002-9149(86)90238-9. [DOI] [PubMed] [Google Scholar]
  9. Kotler T. S., Diamond G. A. Exercise thallium-201 scintigraphy in the diagnosis and prognosis of coronary artery disease. Ann Intern Med. 1990 Nov 1;113(9):684–702. doi: 10.7326/0003-4819-113-9-684. [DOI] [PubMed] [Google Scholar]
  10. Machecourt J., Longère P., Fagret D., Vanzetto G., Wolf J. E., Polidori C., Comet M., Denis B. Prognostic value of thallium-201 single-photon emission computed tomographic myocardial perfusion imaging according to extent of myocardial defect. Study in 1,926 patients with follow-up at 33 months. J Am Coll Cardiol. 1994 Apr;23(5):1096–1106. doi: 10.1016/0735-1097(94)90597-5. [DOI] [PubMed] [Google Scholar]
  11. Porter T. R., Li S., Kilzer K., Deligonul U. Effect of significant two-vessel versus one-vessel coronary artery stenosis on myocardial contrast defects observed with intermittent harmonic imaging after intravenous contrast injection during dobutamine stress echocardiography. J Am Coll Cardiol. 1997 Nov 1;30(5):1399–1406. doi: 10.1016/s0735-1097(97)00290-8. [DOI] [PubMed] [Google Scholar]
  12. Ragosta M., Camarano G., Kaul S., Powers E. R., Sarembock I. J., Gimple L. W. Microvascular integrity indicates myocellular viability in patients with recent myocardial infarction. New insights using myocardial contrast echocardiography. Circulation. 1994 Jun;89(6):2562–2569. doi: 10.1161/01.cir.89.6.2562. [DOI] [PubMed] [Google Scholar]
  13. Sawada S. G., Segar D. S., Ryan T., Brown S. E., Dohan A. M., Williams R., Fineberg N. S., Armstrong W. F., Feigenbaum H. Echocardiographic detection of coronary artery disease during dobutamine infusion. Circulation. 1991 May;83(5):1605–1614. doi: 10.1161/01.cir.83.5.1605. [DOI] [PubMed] [Google Scholar]
  14. Van Lierde J., Piessens J., Glazier J. J., Vrolix M., De Geest H., Willems J. L. Long-term prognosis of male patients with an isolated chronic occlusion of the left anterior descending coronary artery. Am Heart J. 1991 Dec;122(6):1542–1547. doi: 10.1016/0002-8703(91)90269-n. [DOI] [PubMed] [Google Scholar]
  15. Wu J. C., Yun J. J., Heller E. N., Dione D. P., DeMan P., Liu Y. H., Zaret B. L., Wackers F. J., Sinusas A. J. Limitations of dobutamine for enhancing flow heterogeneity in the presence of single coronary stenosis: implications for technetium-99m-sestamibi imaging. J Nucl Med. 1998 Mar;39(3):417–425. [PubMed] [Google Scholar]

Articles from Heart are provided here courtesy of BMJ Publishing Group

RESOURCES