| Milrinone echocardiographic viability test: a pilot study. | |
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MedLine Citation:
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PMID: 11447411 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We assessed the utility of milrinone to predict recovery of function after surgical myocardial revascularization in patients with severe baseline left ventricular systolic dysfunction caused by coronary artery disease (CAD). Prediction of viable myocardial segments that will regain function after revascularization may help in the selection of patients who will benefit from coronary artery bypass graft surgery (CABG) as well as aid in the choice of target sites for coronary revascularization. We investigated 20 consecutive patients with CAD and left ventricular ejection fraction < or = 40% who had evidence of myocardial viability by either thallium scan or dobutamine viability test and were candidates for elective CABG. Left ventricular regional wall motion and global ejection fraction were assessed by transesophageal echocardiography in the operating room. Measurements were done before and 10 minutes after milrinone infusion, and immediately after CABG. Left ventricular wall motion score was derived by means of a 12-segment model. Functional improvement for each segment was defined as a wall motion change > 1. Baseline ejection fraction was 27% +/- 5% (mean +/- SD). Ejection fraction increased to 35% +/- 5% after milrinone infusion (P < .0001) and to 36% +/- 6% after CABG (P < .0001). Post-CABG ejection fraction was significantly correlated with postmilrinone ejection fraction (r = 0.65, P < .0001). Milrinone infusion resulted in augmentation of contraction in 98 of the 209 abnormal segments (wall motion score > or = 2); 91 (92.9%) of these improved after CABG. One hundred nine of the 111 segments that showed no improvement with milrinone did not improve after revascularization (98.2%). Seventy-three segments were akinetic or dyskinetic at baseline; 46 (63.0%) of these improved with milrinone. Improvement in regional wall motion after revascularization was detected in 84.8% of the segments that improved with milrinone versus only 3.7% of the segments that did not improve with milrinone. In patients with ischemic cardiomyopathy, improvement in left ventricular function (segmental wall motion and global ejection fraction) during milrinone infusion is highly predictive of improvement after CABG. |
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Authors:
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S C Dhar; Y Birnbaum; S Hayes; T Naqvi; B Cercek; C Blanche; A Friedman; A Trento; R J Siegel |
Publication Detail:
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Type: Clinical Trial |
Journal Detail:
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Title: Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography Volume: 14 ISSN: 0894-7317 ISO Abbreviation: J Am Soc Echocardiogr Publication Date: 2001 Jul |
Date Detail:
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Created Date: 2001-07-11 Completed Date: 2001-09-13 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8801388 Medline TA: J Am Soc Echocardiogr Country: United States |
Other Details:
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Languages: eng Pagination: 668-75 Citation Subset: IM |
Affiliation:
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Department of Cardiothoracic Surgery, Los Angeles, Calif, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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3',5'-Cyclic-AMP Phosphodiesterases Aged Coronary Artery Bypass* Cyclic Nucleotide Phosphodiesterases, Type 3 Dobutamine / diagnostic use Echocardiography, Transesophageal* Female Hemodynamics / drug effects Humans Male Milrinone / diagnostic use* Myocardial Contraction / drug effects Myocardial Revascularization Patient Selection Phosphodiesterase Inhibitors / diagnostic use, pharmacology Pilot Projects Predictive Value of Tests Radionuclide Ventriculography Recovery of Function Stroke Volume / drug effects Thallium Radioisotopes / diagnostic use Ventricular Dysfunction, Left / complications, surgery* Ventricular Function, Left / drug effects |
| Chemical | |
Reg. No./Substance:
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0/Phosphodiesterase Inhibitors; 0/Thallium Radioisotopes; 34368-04-2/Dobutamine; 78415-72-2/Milrinone; EC 3.1.4.17/3',5'-Cyclic-AMP Phosphodiesterases; EC 3.1.4.17/Cyclic Nucleotide Phosphodiesterases, Type 3 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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