Analysis of microvascular integrity, contractile reserve, and myocardial viability after acute myocardial infarction by dobutamine echocardiography and myocardial contrast echocardiography

Am J Cardiol. 1996 Mar 1;77(7):441-5. doi: 10.1016/s0002-9149(97)89334-4.


The purpose of this study was to evaluate, in postinfarction dysfunctioning myocardium, the relative potential of myocardial contrast and low-dose dobutamine echocardiography in detecting myocardial viability, and the relation between microvascular integrity, contractile reserve, and functional recovery at follow-up. Twenty-four patients with recent myocardial infarction were studied before hospital discharge with low-dose dobutamine and myocardial contrast echocardiography. In the dysfunctioning infarct area, wall motion score index was calculated at baseline, during low-dose dobutamine, and at 3-month follow-up. Revascularization of the infarct-related artery was performed if clinically indicated. Eighteen patients (group A) had myocardial enhancement of the dysfunctioning infarct area at myocardial contrast echocardiography of >50%, whereas the remaining patients (group B) had an increase of < or = 50%. Wall motion score index was similar at baseline in groups A and B (2.6 +/- 0.4 and 2.8 +/- 0.2; p = NS), but it improved during low-dose dobutamine and at follow-up only in group A (1.9 +/- 0.9 and 1.9 +/- 0.7, respectively; p <0.001 vs baseline). In group B, wall motion score index was 2.7 +/- 0.4 with low-dose dobutamine and 2.8 +/- 0.2 at follow-up (p = NS vs rest). In identifying viable myocardial segments, myocardial contrast echo had 100% sensitivity and 46% specificity, whereas low-dose dobutamine echo had 71% sensitivity and 88% specificity. Thus, microvascular integrity after acute myocardial infarction is a fundamental prerequisite for ensuring myocardial contractile reserve and regional functional recovery. Myocardial contrast and low-dose dobutamine echocardiography have different, but complementary, diagnostic characteristics in detecting myocardial viability.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Aged
  • Cardiotonic Agents*
  • Confounding Factors, Epidemiologic
  • Coronary Circulation* / drug effects
  • Dobutamine*
  • Echocardiography / methods*
  • Female
  • Heart / drug effects
  • Heart / physiopathology*
  • Humans
  • Linear Models
  • Male
  • Microcirculation
  • Middle Aged
  • Myocardial Contraction* / drug effects
  • Myocardial Infarction / diagnostic imaging*
  • Myocardial Infarction / physiopathology*
  • Predictive Value of Tests
  • Sensitivity and Specificity


  • Cardiotonic Agents
  • Dobutamine