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Value of low-dose echodobutamine in the diagnosis of patency of the infarct related coronary artery

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Abstract

The resumption of contractility of asynergic segments in survivors after acute myocardial infarction (AMI) may be detected in viable myocardial areas. We have correlated the detection of viable myocardium, assessed with low dose dobutamine testing, with coronary angiography and clinical outcome in 66 consecutive survivors of AMI using the echocardiographic evidence of left ventricular wall motion abnormalities. The test enabled the identification of two groups: group A, comprising 32 patients (pts) demonstrating wall motion recovery at dobutamine infusion and group B, comprising 34 pts without wall motion recovery.

The mean basal asynergy score index was 5.8±4.2 in group A and 6.0±4.2 in group B (p = ns). With dobutamine testing the score decreased to 2.8±3.6 in group A (p < 0.001 with respect to basal value), while it did not change significantly in group B. Left ventricular end diastolic volume (ml) was similar in the two groups (114±35 vs 107±79, p = NS). The infarct related artery (IRA) patency rate was 87.5% in group A, vs 26.5% in group B (p < 0.001). After a mean follow-up of 11±5 months, group A pts had basal asynergy score improvement (2.6±3.1, p < 0.001) and mild left ventricular end diastolic volume (ml) reduction, (108±32, p = NS), while group B pts had left ventricle end diastolic volume enlargement (130±38, p < 0.05), without score asynergy modification. Moreover all pts who experienced heart failure at follow-up were in group B. In our study, wall motion recovery with low dose dobutamine testing detects IRA patency after a first AMI (sensitivity 76%, specificity 86%, diagnostic accuracy 80%, positive predictive value 87%, negative predictive value 73%). IRA patency seems to be related to left ventricular volume reduction and wall motion improvement at follow-up. Low dose dobutamine echocardiography could be useful in detecting pts at risk of left ventricular enlargement after a first AMI.

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Authors and Affiliations

  1. Divisione Cardiologia A. S. Camillo Hospital, 00193, Rome, Italy

    C. Greco, A. Boccanelli, V. Piazza, F. Prati, E. Lioy, E. Zanchi, C. Cecchetti, C. Boschetti, G. Pagamici & P. L. Prati

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  1. C. Greco
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  2. A. Boccanelli
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  3. V. Piazza
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  4. F. Prati
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  5. E. Lioy
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  6. E. Zanchi
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  7. C. Cecchetti
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  8. C. Boschetti
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  9. G. Pagamici
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  10. P. L. Prati
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Greco, C., Boccanelli, A., Piazza, V. et al. Value of low-dose echodobutamine in the diagnosis of patency of the infarct related coronary artery. Int J Cardiac Imag 10, 131–136 (1994). https://doi.org/10.1007/BF01137708

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