Document Detail


Identification of hemodynamically significant restenosis after percutaneous transluminal coronary angioplasty in acute myocardial infarction by transesophageal dobutamine stress echocardiography and comparison with myocardial single photon emission computed tomography.
MedLine Citation:
PMID:  12053386     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Beside thrombolysis, percutaneous transluminal coronary angioplasty (PTCA) has become a well-established treatment for acute myocardial infarction. However, restenosis occurs in approximately 15%-40% of patients. Despite a frequently occurring infarct-related regional systolic dysfunction at rest, the identification of hemodynamically relevant restenosis seems important in terms of risk stratification, adequate treatment, and possible improvement of prognosis in these patients. This study was designed to assess the role of transesophageal dobutamine stress echocardiography and myocardial scintigraphy for identification of hemodynamically significant restenosis after PTCA for acute myocardial infarction. METHODS: Multiplane transesophageal stress echocardiography (dobutamine 5, 10, 20, 30, and 40 micrograms/kg per min) studies and myocardial single photon emission computed tomography (SPECT) studies were performed in 40 patients, all of whom underwent PTCA in the setting of acute myocardial infarction > or = 4 months prior to the test. Repeated coronary angiography was performed in all study patients who showed stress-induced perfusion defects or wall-motion abnormalities, or both. RESULTS: Significant restenosis (> or = 50%) was angiographically found in 15 (37.5%) of 40 patients. Of these 15 patients, transesophageal dobutamine stress echocardiography identified restenosis in 12 (80%) and myocardial SPECT in 14 (93%), yielding diagnostic agreement in 70% of patients. Echocardiographic detection of restenosis was based mainly on a biphasic response to increasing doses of dobutamine. Sensitivity and specificity for identification of hemodynamically relevant restenosis in individual patients was 80% and 92%, respectively for dobutamine stress echocardiography versus 93% and 68% for myocardial SPECT. CONCLUSIONS: Both transesophageal dobutamine stress echocardiography and myocardial SPECT were highly sensitive in identifying significant restenosis after PTCA for acute myocardial infarction. Therefore, either test, as a single diagnostic tool or especially if performed together, are clinically valuable alternatives to coronary angiography for the detection of restenosis after PTCA for acute myocardial infarction.
Authors:
S Rosenkranz; E Voth; K Larosée; F M Baer; K Kettering; K Smolarz; D Moka; H Schicha; E Erdmann; H J Deutsch
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of interventional cardiology     Volume:  14     ISSN:  0896-4327     ISO Abbreviation:  J Interv Cardiol     Publication Date:  2001 Jun 
Date Detail:
Created Date:  2002-06-10     Completed Date:  2002-06-28     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8907826     Medline TA:  J Interv Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  271-82     Citation Subset:  IM    
Affiliation:
Klinik III für Innere Medizin, Klinik, Universität zu Köln, Joseph-Stelzmann-Str. 9, 50924 Köln, Lindenthal, Germany.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Aged
Angioplasty, Transluminal, Percutaneous Coronary*
Cardiotonic Agents / diagnostic use
Coronary Angiography
Coronary Stenosis / diagnosis,  physiopathology*,  therapy*
Dobutamine / diagnostic use
Exercise Test
Female
Hemodynamics*
Humans
Male
Middle Aged
Myocardial Infarction / diagnosis,  physiopathology*,  therapy*
Radiopharmaceuticals
Recurrence
Technetium Tc 99m Sestamibi
Tomography, Emission-Computed, Single-Photon
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 0/Radiopharmaceuticals; 109581-73-9/Technetium Tc 99m Sestamibi; 34368-04-2/Dobutamine

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