Dobutamine-induced ST-segment elevation in patients with acute myocardial infarction and the role of myocardial ischemia, viability, and ventricular dyssynergy

Roberto Ricci, Riccardo Bigi, Alfonso Galati, Paolo Bandini, Claudio Coletta, Cesare Fiorentini, Francesca Lumia, Giuseppe Occhi, Vincenzo Ceci

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)733-737
Number of pages5
JournalThe American Journal of Cardiology
Volume79
Issue number6
DOIs
Publication statusPublished - Mar 15 1997

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Dobutamine-induced ST-segment elevation in patients with acute myocardial infarction and the role of myocardial ischemia, viability, and ventricular dyssynergy'. Together they form a unique fingerprint.

Cite this