TY - JOUR
T1 - Dobutamine-induced ST-segment elevation in patients with acute myocardial infarction and the role of myocardial ischemia, viability, and ventricular dyssynergy
AU - Ricci, Roberto
AU - Bigi, Riccardo
AU - Galati, Alfonso
AU - Bandini, Paolo
AU - Coletta, Claudio
AU - Fiorentini, Cesare
AU - Lumia, Francesca
AU - Occhi, Giuseppe
AU - Ceci, Vincenzo
PY - 1997/3/15
Y1 - 1997/3/15
N2 - We analyzed the relation between dobutamine-induced Q-wave ST-segment elevation and regional contraction during low (5 to 10 μg/kg/min) and high doses (20 to 40 μg/kg/min) of dobutamine in a series of 391 dobutamine echocardiographic tests performed 10 ± 2 days after a first uncomplicated acute myocardial infarction (AMI). ST-segment elevation was defined as ≤1 mm new or additional J-point elevation with a horizontal or upsloping ST segment lasting 80 ms. Wall motion score index at rest was derived using a 16 segment-4 grade score model. Patients with dobutamine-induced ST-segment elevation had a higher wall motion score index at rest (anterior wall AMI: 1.67 ± 0.27 vs 1.43 ± 0.30, p = 0.0001; inferior wall AMI: 1.44 ± 0.27 vs 1.30 ± 0.18, p = 0.0001) and similar incidence and extent of myocardial viability and homozonal ischemia in comparison with those without ST-segment elevation. The sensitivity, specificity, and accuracy of dobutamine-induced ST-segment elevation for detecting residual homozonal ischemia were 51%, 55%, and 54%, respectively, in patients with anterior wall AMI, and 42%, 68%, and 58%, respectively, in patients with inferior wall AMI. In conclusion, dobutamine-induced ST-segment elevation is not associated with higher incidence and extent of viable or jeopardized myocardium but rather to a greater extent of wall motion abnormalities at rest. Thus, this finding does not represent a clinically reliable discriminator for selecting patients for coronary angiography and possible revascularization procedures.
AB - We analyzed the relation between dobutamine-induced Q-wave ST-segment elevation and regional contraction during low (5 to 10 μg/kg/min) and high doses (20 to 40 μg/kg/min) of dobutamine in a series of 391 dobutamine echocardiographic tests performed 10 ± 2 days after a first uncomplicated acute myocardial infarction (AMI). ST-segment elevation was defined as ≤1 mm new or additional J-point elevation with a horizontal or upsloping ST segment lasting 80 ms. Wall motion score index at rest was derived using a 16 segment-4 grade score model. Patients with dobutamine-induced ST-segment elevation had a higher wall motion score index at rest (anterior wall AMI: 1.67 ± 0.27 vs 1.43 ± 0.30, p = 0.0001; inferior wall AMI: 1.44 ± 0.27 vs 1.30 ± 0.18, p = 0.0001) and similar incidence and extent of myocardial viability and homozonal ischemia in comparison with those without ST-segment elevation. The sensitivity, specificity, and accuracy of dobutamine-induced ST-segment elevation for detecting residual homozonal ischemia were 51%, 55%, and 54%, respectively, in patients with anterior wall AMI, and 42%, 68%, and 58%, respectively, in patients with inferior wall AMI. In conclusion, dobutamine-induced ST-segment elevation is not associated with higher incidence and extent of viable or jeopardized myocardium but rather to a greater extent of wall motion abnormalities at rest. Thus, this finding does not represent a clinically reliable discriminator for selecting patients for coronary angiography and possible revascularization procedures.
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U2 - 10.1016/S0002-9149(96)00859-4
DO - 10.1016/S0002-9149(96)00859-4
M3 - Article
C2 - 9070550
AN - SCOPUS:0030901343
VL - 79
SP - 733
EP - 737
JO - American Journal of Cardiology
JF - American Journal of Cardiology
SN - 0002-9149
IS - 6
ER -