Document Detail


Combined assessment of microvascular integrity and contractile reserve improves differentiation of stunning and necrosis after acute anterior wall myocardial infarction.
MedLine Citation:
PMID:  12354431     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: We sought to determine the relative accuracy of myocardial contrast echocardiography (MCE) and low-dose dobutamine echocardiography (LDDE) in predicting recovery of left ventricular (LV) function in patients with a recent anterior wall myocardial infarction (MI). BACKGROUND: Left ventricular dysfunction after acute MI may be secondary to myocardial stunning or necrosis. Myocardial contrast echocardiography allows real-time echocardiographic perfusion assessment from a venous injection of a fluorocarbon-based contrast agent. Although this technique is promising, it has not been compared with LDDE. METHODS: Forty-six patients underwent baseline wall motion assessment, MCE, and LDDE two days after admission, as well as follow-up echocardiography after a mean period of 53 days. RESULTS: Perfusion by MCE predicted recovery of segmental function with a sensitivity of 69%, specificity of 85%, positive predictive value of 74%, negative predictive value of 81%, and overall accuracy of 78%. Contractile reserve by LDDE predicted recovery of segmental function with a sensitivity of 50%, specificity of 88%, positive predictive value of 72%, negative predictive value of 73%, and overall accuracy of 73%. Concordant test results occurred in 74% of segments and further increased the overall accuracy to 85%. The mean wall motion score at follow-up was significantly better in perfused versus nonperfused segments (1.9 vs. 2.6, p < 0.0001) and in segments with contractile reserve, compared with segments lacking contractile reserve (1.9 vs. 2.5, p < 0.0001). CONCLUSION: Myocardial contrast echocardiography compares favorably with LDDE in predicting recovery of regional LV dysfunction after acute anterior wall MI. Concordant contractile reserve and myocardial perfusion results further enhance the diagnostic accuracy.
Authors:
Michael L Main; Anthony Magalski; Becky A Morris; Michael M Coen; David G Skolnick; Thomas H Good
Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  40     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2002 Sep 
Date Detail:
Created Date:  2002-09-30     Completed Date:  2002-10-16     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1079-84     Citation Subset:  AIM; IM    
Affiliation:
Mid America Heart Institute, Kansas City, Missouri 64111, USA. mmain@cc-pc.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Circulation / physiology*
Dose-Response Relationship, Drug
Echocardiography*
Echocardiography, Stress*
Female
Humans
Male
Middle Aged
Myocardial Contraction / physiology*
Myocardial Infarction / complications*,  physiopathology*,  ultrasonography
Myocardial Stunning / etiology*,  physiopathology*,  ultrasonography
Necrosis
Predictive Value of Tests
Prospective Studies
Recovery of Function / physiology*
Reproducibility of Results
Sensitivity and Specificity
Ventricular Dysfunction, Left / etiology*,  physiopathology*,  ultrasonography

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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