当前位置： SCI文献检索 > JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY期刊下所有文献 > Low-level exercise echocardiography detects contractile reserve and predicts reversible dysfunction after acute myocardial infarction: comparison with low-dose dobutamine echocardiography.

Low-level exercise echocardiography detects contractile reserve and predicts reversible dysfunction after acute myocardial infarction: comparison with low-dose dobutamine echocardiography.

Abstract：

OBJECTIVES:The aim of this study was to evaluate low-level exercise echocardiography (LLEE) in detecting contractile reserve and predicting functional improvement of akinetic myocardium early after acute myocardial infarction (AMI). BACKGROUND:Experimental and clinical studies have shown that low-dose dobutamine enhances contractile function of dyssynergic but viable myocardium in patients with recent AMI. We hypothesized that endogenous catecholamines produced during a LLEE test could serve as a myocardial stressor to elicit contractile reserve. METHODS:Fifty-two consecutive patients with first AMI and > or =2 akinetic segments in the infarct-related territory underwent 5 +/- 2 days after AMI low-dose dobutamine echocardiography (LDDE) (5, 10 and 15 microg/kg/min) and LLEE (25 W during 3 min on a supine bicycle, with continuous echocardiographic recording). Both tests were performed on the same day, in random order. Follow-up echocardiography was obtained one month later. Regional wall thickening was semi-quantitatively assessed using a 16-segment, 5-grade scale model. Contractile reserve was defined as improvement in wall thickening of > or =1 grade. RESULTS:Mean increase in heart rate during stress tests was 15 +/- 7 beats/min with LLEE and 13 +/- 6 beats/min with LDDE (p = NS). Contractile reserve was detected in 119 (55%) of 217 akinetic segments at LLEE and in 137 (63%) segments at LDDE. At follow-up study, functional improvement was identified in 139 (64%) segments. Sensitivity, specificity and positive and negative predictive values for predicting functional recovery were 81%, 92%, 95% and 73%, respectively, for LLEE, and 91%, 86%, 92% and 84%, respectively, for LDDE. Moreover, there was a good correlation between systolic wall thickening measured in the center of the dyssynergic area during stress tests and at follow-up study: r = 0.77, p < 0.001 with exercise testing and r = 0.73, p < 0.001 with dobutamine testing. CONCLUSIONS:Low-level exercise echocardiography provides a promising alternative to LDDE for identifying myocardial viability and predicting reversible dysfunction early after AMI.

journal_name

J Am Coll Cardiol

journal_title

Journal of the American College of Cardiology

authors

Hoffer EP,Dewé W,Celentano C,Piérard LA

doi

10.1016/s0735-1097(99)00340-x

subject

Has Abstract

pub_date

1999-10-01 00:00:00

pages

989-97

issue

eissn

0735-1097

issn

1558-3597

pii

S0735-1097(99)00340-X

journal_volume

pub_type

临床试验,杂志文章,随机对照试验

在线工具

Low-level exercise echocardiography detects contractile reserve and predicts reversible dysfunction after acute myocardial infarction: comparison with low-dose dobutamine echocardiography.