Document Detail

Detection and clinical usefulness of a biphasic response during exercise echocardiography early after myocardial infarction.
MedLine Citation:
PMID:  12679214     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The aim of this study was to determine the accuracy of exercise echocardiography (EE) for detecting infarct-related artery (IRA) stenosis and predicting functional recovery early after acute myocardial infarction (AMI). BACKGROUND: Dobutamine stress echocardiography is widely used for identifying jeopardized myocardium. The clinical usefulness of a biphasic response detected during EE has never been investigated. METHODS: A total of 114 consecutive patients with a first AMI and > or = 2 dyssynergic segments in the infarct-related territory underwent semi-supine continuous EE 6 +/- 2 days after AMI. Quantitative coronary angiography was performed in all patients after EE. A follow-up echocardiogram was obtained one month later. RESULTS: Ninety-seven patients had significant (> or = 50%) IRA stenosis, and 26 had multivessel disease. Residual ischemia was identified in 77 patients (biphasic response in 62 and worsening response in 15). The sensitivity and specificity of ischemia during EE for predicting IRA stenosis were 75% and 76%, respectively. The sensitivity of a biphasic response was higher than the sensitivity of a worsening response (61% vs. 14%, p < 0.0001). Wall motion abnormalities induced in other vascular territories were specific (97%) and moderately sensitive (62%) for the detection of multivessel disease. Functional recovery was observed in 75 patients. Two independent variables predicted contractile recovery: contractile reserve during EE (p < 0.0001) and elective angioplasty of the IRA (p = 0.002). A biphasic response, but not sustained improvement, predicted reversible dysfunction (73% vs. 9%, p < 0.0001). CONCLUSIONS: A biphasic response can be detected during exercise. Exercise echocardiography is an accurate tool for detecting IRA stenosis and predicting functional improvement early after AMI.
Patrizio Lancellotti; Etienne P Hoffer; Luc A Piérard
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  41     ISSN:  0735-1097     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2003 Apr 
Date Detail:
Created Date:  2003-04-07     Completed Date:  2003-04-21     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:  1142-7     Citation Subset:  AIM; IM    
Department of Cardiology, University Hospital, Liège, Belgium.
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MeSH Terms
Cardiotonic Agents / diagnostic use
Coronary Angiography
Coronary Disease / ultrasonography
Coronary Stenosis / etiology,  physiopathology,  ultrasonography*
Dobutamine / diagnostic use
Echocardiography, Stress*
Exercise Test / instrumentation*
Middle Aged
Myocardial Infarction / complications,  physiopathology,  ultrasonography*
Predictive Value of Tests
Sensitivity and Specificity
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine

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