Prediction of viability by pulsed-wave Doppler tissue sampling of asynergic myocardium during low-dose dobutamine challenge

Int J Cardiol. 2000 Jul 31;74(2-3):107-13. doi: 10.1016/s0167-5273(00)00226-6.

Abstract

Dobutamine stress echocardiography is widely used to predict reversible left ventricular dysfunction, but evaluation with this method is subjective. Pulsed-wave tissue Doppler imaging is a new technique that allows to obtain quantitative data on wall motion velocities of different myocardial segments through sample-volume placement. Therefore, this tool in combination with DSE may be suitable for identifying viability in asynergic myocardium. To evaluate this, in 40 patients (mean age 57+/-9) with resting dyssynergy (akinesis in 52, hypokinesis in 30) baseline wall motion scores and tissue Doppler variables were collected before and after 5 min infusion of 10 microg/kg per min dobutamine. Forty-six of 82 segments were classified as viable (a reduction in segmental score of at least one grade) according to follow-up echocardiography that was performed 4 weeks after revascularization. While myocardial S velocity percent increase in viable segments was 45+/-10, the increase was 25+/-12 in necrotic segments (n=36) during 10 microg dobutamine infusion (P=0.0001). Assuming 35% as a cut-off for viability the increase in S velocities by DSE yielded an 89% sensitivity and 86% specificity for predicting post-revascularization functional recovery. In conclusion, pulsed-wave tissue Doppler imaging of asynergic myocardium during dobutamine stress echocardiography can identify the viability quantitatively.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Cardiotonic Agents*
  • Coronary Angiography
  • Coronary Disease / diagnostic imaging*
  • Coronary Disease / therapy
  • Dobutamine*
  • Dose-Response Relationship, Drug
  • Echocardiography, Doppler / methods*
  • Exercise Test / methods*
  • Hemodynamics / physiology
  • Humans
  • Middle Aged
  • Myocardial Contraction / drug effects
  • Myocardial Revascularization
  • Predictive Value of Tests
  • Preoperative Care
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Ventricular Dysfunction, Left / diagnostic imaging*

Substances

  • Cardiotonic Agents
  • Dobutamine