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. 1996 Mar;75(3):240–246. doi: 10.1136/hrt.75.3.240

Comparison of dobutamine stress echocardiography with dipyridamole stress echocardiography for detection of viable myocardium after myocardial infarction treated with thrombolysis.

A Poli 1, M Previtali 1, L Lanzarini 1, R Fetiveau 1, P Diotallevi 1, M Ferrario 1, A Mussini 1, G Specchia 1, C Montemartini 1
PMCID: PMC484279  PMID: 8800985

Abstract

OBJECTIVE: To compare the ability of dobutamine and dipyridamole stress echocardiography to detect functional recovery of stunned but viable myocardial regions early after acute myocardial infarction, and to predict late functional recovery of the reperfusion salvaged myocardium within the infarct area. METHODS: Within 10 d of acute myocardial infarction, 51 patients--30 anterior and 21 inferior, 44 Q wave and seven non-Q-wave infarction--were submitted to a dobutamine echocardiography test at low dose (5-10 micrograms/kg/min over 5 min) and high dose (20-40 micrograms/kg/min over 3 min) and to dipyridamole echocardiography test (0.56 mg/kg over 4 min + 0.28 mg/kg over 2 min) on different days and in random order, after interruption of any vasoactive drug. Resting echocardiography was repeated at two months in 41 of 51 patients (80%). Regional wall motion of the left ventricle was analysed in a semiquantitative manner on a 14-segment model. Viability was defined as improvement of one grade or more of at least two basally asynergic segments in the infarcted area. RESULTS: Regional functional recovery was detected by low dose dobutamine in 38/51 patients (75%) and in 147/308 (48%) of basally asynergic segments, compared to 25/51 patients (49%; P < 0.001) and 78/308 segments (25%; P < 0.001) only identified by dipyridamole. Late spontaneous functional recovery was detected in 24/41 patients (59%) and in 78/254 basally asynergic segments (31%). The sensitivity of dobutamine and dipyridamole echocardiography for predicting spontaneous functional recovery was 72% and 51% respectively (P < 0.001), specificity 68% and 82% (P < 0.001), positive predictive value 50% and 56%, and negative predictive value 85% and 79%. CONCLUSIONS: In comparison with dipyridamole in patients with thrombolysed myocardial infarction, dobutamine induces regional functional recovery. This suggests that dobutamine is more sensitive in showing the presence of viable myocardium within the infarct zone, though it has a lower specificity in predicting delayed spontaneous functional recovery of non-contractile but still viable areas.

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Selected References

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  1. Agati L., Voci P., Bilotta F., Luongo R., Autore C., Penco M., Iacoboni C., Fedele F., Dagianti A. Influence of residual perfusion within the infarct zone on the natural history of left ventricular dysfunction after acute myocardial infarction: a myocardial contrast echocardiographic study. J Am Coll Cardiol. 1994 Aug;24(2):336–342. doi: 10.1016/0735-1097(94)90285-2. [DOI] [PubMed] [Google Scholar]
  2. Barilla F., Gheorghiade M., Alam M., Khaja F., Goldstein S. Low-dose dobutamine in patients with acute myocardial infarction identifies viable but not contractile myocardium and predicts the magnitude of improvement in wall motion abnormalities in response to coronary revascularization. Am Heart J. 1991 Dec;122(6):1522–1531. doi: 10.1016/0002-8703(91)90267-l. [DOI] [PubMed] [Google Scholar]
  3. Bolli R., Zhu W. X., Myers M. L., Hartley C. J., Roberts R. Beta-adrenergic stimulation reverses postischemic myocardial dysfunction without producing subsequent functional deterioration. Am J Cardiol. 1985 Dec 1;56(15):964–968. doi: 10.1016/0002-9149(85)90413-8. [DOI] [PubMed] [Google Scholar]
  4. Braunwald E., Kloner R. A. The stunned myocardium: prolonged, postischemic ventricular dysfunction. Circulation. 1982 Dec;66(6):1146–1149. doi: 10.1161/01.cir.66.6.1146. [DOI] [PubMed] [Google Scholar]
  5. Braunwald E. Myocardial reperfusion, limitation of infarct size, reduction of left ventricular dysfunction, and improved survival. Should the paradigm be expanded? Circulation. 1989 Feb;79(2):441–444. doi: 10.1161/01.cir.79.2.441. [DOI] [PubMed] [Google Scholar]
  6. Buda A. J., Zotz R. J., Gallagher K. P. Characterization of the functional border zone around regionally ischemic myocardium using circumferential flow-function maps. J Am Coll Cardiol. 1986 Jul;8(1):150–158. doi: 10.1016/s0735-1097(86)80106-1. [DOI] [PubMed] [Google Scholar]
  7. Edwards W. D., Tajik A. J., Seward J. B. Standardized nomenclature and anatomic basis for regional tomographic analysis of the heart. Mayo Clin Proc. 1981 Aug;56(8):479–497. [PubMed] [Google Scholar]
  8. Ellis S. G., Henschke C. I., Sandor T., Wynne J., Braunwald E., Kloner R. A. Time course of functional and biochemical recovery of myocardium salvaged by reperfusion. J Am Coll Cardiol. 1983 Apr;1(4):1047–1055. doi: 10.1016/s0735-1097(83)80107-7. [DOI] [PubMed] [Google Scholar]
  9. Ellis S. G., Wynne J., Braunwald E., Henschke C. I., Sandor T., Kloner R. A. Response of reperfusion-salvaged, stunned myocardium to inotropic stimulation. Am Heart J. 1984 Jan;107(1):13–19. doi: 10.1016/0002-8703(84)90126-1. [DOI] [PubMed] [Google Scholar]
  10. Gallagher K. P., Gerren R. A., Stirling M. C., Choy M., Dysko R. C., McManimon S. P., Dunham W. R. The distribution of functional impairment across the lateral border of acutely ischemic myocardium. Circ Res. 1986 Apr;58(4):570–583. doi: 10.1161/01.res.58.4.570. [DOI] [PubMed] [Google Scholar]
  11. Galli M., Marcassa C., Bolli R., Giannuzzi P., Temporelli P. L., Imparato A., Silva Orrego P. L., Giubbini R., Giordano A., Tavazzi L. Spontaneous delayed recovery of perfusion and contraction after the first 5 weeks after anterior infarction. Evidence for the presence of hibernating myocardium in the infarcted area. Circulation. 1994 Sep;90(3):1386–1397. doi: 10.1161/01.cir.90.3.1386. [DOI] [PubMed] [Google Scholar]
  12. Leung W. H., Lau C. P. Effects of severity of the residual stenosis of the infarct-related coronary artery on left ventricular dilation and function after acute myocardial infarction. J Am Coll Cardiol. 1992 Aug;20(2):307–313. doi: 10.1016/0735-1097(92)90095-5. [DOI] [PubMed] [Google Scholar]
  13. Lucarini A. R., Picano E., Marini C., Favilla S., Salvetti A., Distante A. Activation of sympathetic tone during dipyridamole test. Chest. 1992 Aug;102(2):444–447. doi: 10.1378/chest.102.2.444. [DOI] [PubMed] [Google Scholar]
  14. O'Rourke M., Baron D., Keogh A., Kelly R., Nelson G., Barnes C., Raftos J., Graham K., Hillman K., Newman H. Limitation of myocardial infarction by early infusion of recombinant tissue-type plasminogen activator. Circulation. 1988 Jun;77(6):1311–1315. doi: 10.1161/01.cir.77.6.1311. [DOI] [PubMed] [Google Scholar]
  15. Picano E., Marzullo P., Gigli G., Reisenhofer B., Parodi O., Distante A., L'Abbate A. Identification of viable myocardium by dipyridamole-induced improvement in regional left ventricular function assessed by echocardiography in myocardial infarction and comparison with thallium scintigraphy at rest. Am J Cardiol. 1992 Sep 15;70(7):703–710. doi: 10.1016/0002-9149(92)90545-a. [DOI] [PubMed] [Google Scholar]
  16. Picard M. H., Wilkins G. T., Ray P., Weyman A. E. Long-term effects of acute thrombolytic therapy on ventricular size and function. Am Heart J. 1993 Jul;126(1):1–10. doi: 10.1016/s0002-8703(07)80003-2. [DOI] [PubMed] [Google Scholar]
  17. Piérard L. A., De Landsheere C. M., Berthe C., Rigo P., Kulbertus H. E. Identification of viable myocardium by echocardiography during dobutamine infusion in patients with myocardial infarction after thrombolytic therapy: comparison with positron emission tomography. J Am Coll Cardiol. 1990 Apr;15(5):1021–1031. doi: 10.1016/0735-1097(90)90236-i. [DOI] [PubMed] [Google Scholar]
  18. Rahimtoola S. H. The hibernating myocardium. Am Heart J. 1989 Jan;117(1):211–221. doi: 10.1016/0002-8703(89)90685-6. [DOI] [PubMed] [Google Scholar]
  19. Ralevic V., Burnstock G. Roles of P2-purinoceptors in the cardiovascular system. Circulation. 1991 Jul;84(1):1–14. doi: 10.1161/01.cir.84.1.1. [DOI] [PubMed] [Google Scholar]
  20. Serruys P. W., Simoons M. L., Suryapranata H., Vermeer F., Wijns W., van den Brand M., Bär F., Zwaan C., Krauss X. H., Remme W. J. Preservation of global and regional left ventricular function after early thrombolysis in acute myocardial infarction. J Am Coll Cardiol. 1986 Apr;7(4):729–742. doi: 10.1016/s0735-1097(86)80330-8. [DOI] [PubMed] [Google Scholar]
  21. Simoons M. L., Serruys P. W., vd Brand M., Bär F., de Zwaan C., Res J., Verheugt F. W., Krauss X. H., Remme W. J., Vermeer F. Improved survival after early thrombolysis in acute myocardial infarction. A randomised trial by the Interuniversity Cardiology Institute in The Netherlands. Lancet. 1985 Sep 14;2(8455):578–582. doi: 10.1016/s0140-6736(85)90584-7. [DOI] [PubMed] [Google Scholar]
  22. Smart S. C., Sawada S., Ryan T., Segar D., Atherton L., Berkovitz K., Bourdillon P. D., Feigenbaum H. Low-dose dobutamine echocardiography detects reversible dysfunction after thrombolytic therapy of acute myocardial infarction. Circulation. 1993 Aug;88(2):405–415. doi: 10.1161/01.cir.88.2.405. [DOI] [PubMed] [Google Scholar]
  23. Stadius M. L., Davis K., Maynard C., Ritchie J. L., Kennedy J. W. Risk stratification for 1 year survival based on characteristics identified in the early hours of acute myocardial infarction. The Western Washington Intracoronary Streptokinase Trial. Circulation. 1986 Oct;74(4):703–711. doi: 10.1161/01.cir.74.4.703. [DOI] [PubMed] [Google Scholar]
  24. Stahl L. D., Aversano T. R., Becker L. C. Selective enhancement of function of stunned myocardium by increased flow. Circulation. 1986 Oct;74(4):843–851. doi: 10.1161/01.cir.74.4.843. [DOI] [PubMed] [Google Scholar]
  25. White H. D., Norris R. M., Brown M. A., Takayama M., Maslowski A., Bass N. M., Ormiston J. A., Whitlock T. Effect of intravenous streptokinase on left ventricular function and early survival after acute myocardial infarction. N Engl J Med. 1987 Oct 1;317(14):850–855. doi: 10.1056/NEJM198710013171402. [DOI] [PubMed] [Google Scholar]

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