Document Detail

Contractile reserve in segments with nontransmural infarction in chronic dysfunctional myocardium using low-dose dobutamine CMR.
MedLine Citation:
PMID:  20541717     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: This study sought to quantify contractile reserve of chronic dysfunctional myocardium, in particular in segments with intermediate transmural extent of infarction (TEI), using low-dose dobutamine cardiac magnetic resonance (CMR) in patients with a chronic total coronary occlusion (CTO). BACKGROUND: Recovery of dysfunctional segments with intermediate TEI after percutaneous coronary intervention is variable and difficult to predict, and may be related to contractility of the unenhanced rim. METHODS: Fifty-one patients (mean age 60 +/- 9 years, 76% male) with a CTO underwent CMR at baseline and 35 patients underwent CMR at follow-up to quantify segmental wall thickening (SWT) at rest during 5 and 10 microg/kg/min dobutamine, and at follow-up. Delayed-enhancement CMR was performed to quantify TEI. Dysfunctional segments were stratified according to TEI, end-diastolic wall thickness (EDWT), or unenhanced rim thickness, and SWT was quantified. Segments with an intermediate TEI (25% to 75%) were further stratified according to baseline SWT of the unenhanced rim (SWT(UR)) (<45% and >45%), and SWT was quantified. For each parameter, odds ratio (OR) and diagnostic performance for the prediction of contractile reserve were calculated. RESULTS: Significant contractile reserve was present in dysfunctional segments with EDWT >6 mm, unenhanced rim thickness >3 mm, or TEI of <25%; only TEI had significant relation with contractile reserve (OR: 0.98; 95% confidence interval [CI]: 0.96 to 0.99; p = 0.02). In segments with intermediate TEI (n = 58), mean SWT did not improve significantly. However, segments with SWT(UR) <45% showed contractile reserve and improved at follow-up, whereas segments with SWT(UR) >45% were unchanged. SWT(UR) had a significant relation with contractile reserve (OR: 0.98; 95% CI: 0.97 to 0.99; p = 0.02). CONCLUSIONS: CMR quantification of transmurality of infarcted myocardium allows the assessment of the potential of dysfunctional segments to improve in function during dobutamine of most segments. However, in segments with intermediate TEI, measurement of baseline contractility of the epicardial rim better identifies which segments maintain contractile reserve.
Sharon W Kirschbaum; Alexia Rossi; Ron T van Domburg; Katerina Gruszczynska; Gabriel P Krestin; Patrick W Serruys; Dirk J Duncker; Pim J de Feyter; Robert-Jan M van Geuns
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  3     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-14     Completed Date:  2010-09-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  614-22     Citation Subset:  IM    
Copyright Information:
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary*
Contrast Media / diagnostic use
Coronary Occlusion / complications*,  diagnosis,  physiopathology,  therapy
Dobutamine / administration & dosage,  diagnostic use*
Gadolinium DTPA / diagnostic use
Infusions, Intravenous
Logistic Models
Magnetic Resonance Imaging, Cine*
Middle Aged
Myocardial Contraction*
Myocardial Infarction / diagnosis*,  etiology,  physiopathology,  therapy
Myocardium / pathology*
Odds Ratio
Predictive Value of Tests
Prospective Studies
Recovery of Function
Time Factors
Treatment Outcome
Reg. No./Substance:
0/Contrast Media; 34368-04-2/Dobutamine; 80529-93-7/Gadolinium DTPA

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