Document Detail


Magnetic resonance tagging and echocardiographic response to dobutamine and functional improvement after reperfused myocardial infarction.
MedLine Citation:
PMID:  12075262     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Our objective was to compare the qualitative response to low-dose dobutamine by echocardiography (DSE) with the quantitative response of magnetic resonance myocardial tagging (DMRT) in the prediction and evaluation of functional improvement after reperfused myocardial infarction (MI). METHODS: Twenty-two patients with a reperfused first MI (aged 51 +/- 2 years, 20 male, 13 anterior MI) were studied. On day 3 +/- 1 after MI, patients underwent both DSE and DMRT at baseline and during infusion of 5 microg/kg/min and 10 microg/kg/min of dobutamine. The patients returned at week 8 +/- 1 for follow-up echocardiogram and MRT at rest. Two experienced observers interpreted the DSE for the presence of contractile reserve and functional improvement in dysfunctional segments. By DMRT, a 5% increase in percent intramyocardial circumferential shortening at peak response to dobutamine was defined as evidence of contractile reserve. Functional improvement by echocardiography was defined as the gold standard. RESULTS: Ejection fraction improved from 46% +/- 10% at week 1 to 51% +/- 12% at week 8 (P <.001) in the patients. Sixty-seven transmural segments with baseline dysfunction matched between imaging modalities by location were studied. For 51 (76%) of the segments, echocardiography and MR tagging were concordant in the assessment of functional improvement (kappa value 0.52). Twenty-nine segments (43%) demonstrated improvement by echocardiography, whereas 33 segments (49%) improved by MR tagging. With improvement of function by echocardiography as gold standard, the sensitivity and specificity of DMRT for prediction of functional improvement was 86% and 69%, respectively, with an overall accuracy of 76%. The sensitivity, specificity, and accuracy of DSE was 86%, 87%, and 85%, respectively. Overall accuracy was similar between techniques. CONCLUSIONS: Both DSMRT and DSE are sensitive and accurate techniques for predicting functional improvement after reperfused MI.
Authors:
Christopher M Kramer; Michael J Malkowski; Sunil Mankad; Therese M Theobald; Diana L Pakstis; Walter J Rogers
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  143     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2002 Jun 
Date Detail:
Created Date:  2002-06-20     Completed Date:  2002-07-18     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1046-51     Citation Subset:  AIM; IM    
Affiliation:
Department of Medicine, the University of Virginia Health System, Charlottesville, Va 22908, USA. ckramer@virginia.edu
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MeSH Terms
Descriptor/Qualifier:
Cardiotonic Agents / administration & dosage,  diagnostic use*
Dobutamine / administration & dosage,  diagnostic use*
Echocardiography*
Female
Humans
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Myocardial Contraction
Myocardial Infarction / physiopathology*,  therapy,  ultrasonography
Myocardial Reperfusion
Myocardial Stunning / physiopathology,  therapy,  ultrasonography
Sensitivity and Specificity
Stroke Volume
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine

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