| Low-dose dobutamine testing using contrast left ventriculography in the same session as coronary angiography predicts the improvement of left ventricular function after coronary angioplasty in postinfarction patients. | |
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MedLine Citation:
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PMID: 10073778 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The role of percutaneous transluminal coronary angioplasty (PTCA) in the subacute or chronic phases of myocardial infarction remains controversial. This study investigates the usefulness of dobutamine contrast left ventriculography in a single session with coronary angiography for predicting the improvement of ventricular function after PTCA. The study group consisted of 30 patients in whom a contrast left ventricular angiogram and PTCA were performed after a first myocardial infarction. The centerline method was used to calculate dysfunction extent at baseline and its variation during dobutamine infusion at 7.5 microg/kg/min; contractile reserve was defined as a significant (> or = 15%) reduction of dysfunction extent. A second ventricular angiogram was performed 6 months later in all patients. Abnormal wall motion extent decreased at 6 months after PTCA (84+/-21% vs 70+/-29%, p = 0.0001). Wall motion improvement after PTCA correlated with the response to dobutamine (r = 0.54, p = 0.002). Ten patients showed a significant reduction (> or = 15%) of dysfunction extent at 6 months; dobutamine testing had a 80% sensitivity, 84% specificity, 67% positive predictive value, and 89% negative predictive value in detecting regional function improvement. In the subgroup of 21 patients without restenosis, both the correlation between dysfunction improvement after PTCA and response to dobutamine (r = 0.72, p = 0.0001) and the accuracy of dobutamine testing (sensitivity 88%, specificity 92%, positive predictive value 88%, and negative predictive value 92%) increased. The ejection fraction significantly increased (>5%) after PTCA in 6 patients; dobutamine testing had a 67% sensitivity, 74% specificity, 44% positive predictive value, and 88% negative predictive value in predicting the increase in the ejection fraction. In the subgroup without restenosis the improvement of the ejection fraction correlated with the response to dobutamine (r = 0.63, p = 0.007), and the sensitivity of dobutamine testing was 80%, specificity 83%, positive predictive value 67%, and negative predictive value 91%. In conclusion, dobutamine contrast left ventriculography testing in the same session as coronary angiography predicts regional function and ejection fraction improvement after PTCA in postinfarction patients, particularly when restenosis does not develop. |
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Authors:
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J Sanchis; V Bodí; L Insa; R Gómez-Aldaraví; A Berenguer; M P López-Lereu; F J Chorro; V López-Merino |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: The American journal of cardiology Volume: 83 ISSN: 0002-9149 ISO Abbreviation: Am. J. Cardiol. Publication Date: 1999 Jan |
Date Detail:
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Created Date: 1999-03-16 Completed Date: 1999-03-16 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 15-20 Citation Subset: AIM; IM |
Affiliation:
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Service of Cardiology, University Clinic Hospital, Valencia, Spain. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary* Cardiotonic Agents / administration & dosage, diagnostic use* Coronary Angiography* Dobutamine / administration & dosage, diagnostic use* Female Heart Ventricles / radiography* Humans Linear Models Male Middle Aged Myocardial Infarction / complications, physiopathology, radiography*, therapy* Observer Variation Predictive Value of Tests Stroke Volume Ventricular Dysfunction, Left / etiology, physiopathology, radiography* Ventricular Function, Left* |
| Chemical | |
Reg. No./Substance:
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0/Cardiotonic Agents; 34368-04-2/Dobutamine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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