Document Detail

Myocardial blood flow at rest and contractile reserve in patients with chronic coronary artery disease and left ventricular dysfunction.
MedLine Citation:
PMID:  10548143     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The mechanisms that determine chronic left ventricular dysfunction in coronary artery disease (in particular, critical reductions in coronary artery blood flow leading to hibernating myocardium) may affect the ability of the myocardium to respond to inotropic stimulation with dobutamine. This study was designed to investigate the relationship between resting myocardial blood flow and contractile reserve in patients with coronary artery disease and chronic left ventricular dysfunction. METHODS AND RESULTS: Twenty-three patients (21 men and 2 women; age 61 +/- 9 years) underwent transesophageal echocardiography during infusion of dobutamine (2.5 microg/kg to 40 microg/kg per minute) and positron emission tomography (PET) with 150-water (9 patients) or 13N-ammonia (14 patients). Systolic wall thickening at each dose of dobutamine and resting myocardial blood flow were quantitatively analyzed in 8 anatomically matched regions at mid-ventricular level. Myocardial regions with preserved contraction had higher blood flow compared with regions with basal dyssynergy (0.99 +/- 0.3 vs 0.65 +/- 0.3 mL/min/gm; P < .0001). Among myocardial regions with preserved resting contraction, no relation was observed between blood flow and the response to dobutamine (r = 0.06). In contrast, among myocardial regions with diminished resting contraction, a significant correlation was observed between resting blood flow and contractile reserve (r = 0.53; P < .0001). The maximum increase in percent systolic wall thickening with dobutamine was 32.8% +/- 14% in regions with normal blood flow, 21.5% +/- 17% in regions with mildly to moderately reduced blood flow, and 10.7% +/- 10% in regions with severely reduced blood flow (P < .0001). CONCLUSIONS: These findings emphasize the importance of resting myocardial blood flow for the preservation of contractile reserve in patients with coronary artery disease and left ventricular dysfunction. Because a positive inotropic response to dobutamine is more likely to occur in dyssynergic regions with preserved rather than reduced myocardial blood flow, regional perfusion may determine in which circumstances dobutamine echocardiography contributes to the assessment of myocardial viability.
J A Panza; V Dilsizian; R V Curiel; E F Unger; J M Laurienzo; A N Kitsiou
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology     Volume:  6     ISSN:  1071-3581     ISO Abbreviation:  J Nucl Cardiol     Publication Date:    1999 Sep-Oct
Date Detail:
Created Date:  1999-11-24     Completed Date:  1999-11-24     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9423534     Medline TA:  J Nucl Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  487-94     Citation Subset:  IM    
Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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MeSH Terms
Chronic Disease
Coronary Circulation*
Coronary Disease / complications,  physiopathology*,  radionuclide imaging,  ultrasonography
Dobutamine / diagnostic use
Echocardiography, Transesophageal
Middle Aged
Myocardial Contraction*
Stimulation, Chemical
Tomography, Emission-Computed
Ventricular Dysfunction, Left / complications,  physiopathology*,  radionuclide imaging
Reg. No./Substance:

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