Document Detail

Observation of the ischemic cascade in humans using contrast echocardiography during dobutamine stress.
MedLine Citation:
PMID:  12736478     Owner:  NLM     Status:  MEDLINE    
Experimental studies have postulated the ischemic cascade and the present study was designed to elucidate whether it can be observed in the clinical setting. Fifty-three patients suspected of having coronary artery disease were studied. Myocardial perfusion abnormalities (MPA) and wall motion abnormalities (WMA) were assessed simultaneously by infusion of Levovist during dobutamine stress echocardiography. Time - intensity data of myocardial opacification were fitted for Y=A (1-e(-)(beta) (t)) from which the rate of increase (beta) of intensity were derived both at rest and during stress. Wall motion was also given a score. Bright opacification was observed in 50 patients: 25 showed significant stenosis (>50%) in the left anterior descending artery (group II) on coronary angiography and 25 did not (group I). Significant differences were found in the beta ratio (stress/rest) between the 2 groups at a low-dose (2.0+/-0.3 vs 1.5+/-0.5, p<0.05) and at a high-dose of dobutamine (2.7+/-1.0 vs 1.1+/-0.5, p<0.001), whereas the wall motion score differed only at a high-dose. Of the 25 patients in group II, MPA preceded WMA in 12, both occurred at the same stage in 12, and neither MPA nor WMA was seen in 1. These data prove the ischemic cascade clinically, using contrast echocardiography, by demonstrating that MPA precede WMA during dobutamine stress in patients with coronary stenosis.
Eiichi Hyodo; Takashi Muro; Takeshi Hozumi; Shota Fukuda; Hiroyuki Watanebe; Minoru Yoshiyama; Kazuhide Takeuchi; Hiroshi Iwao; Junichi Yoshikawa
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  67     ISSN:  1346-9843     ISO Abbreviation:  Circ. J.     Publication Date:  2003 May 
Date Detail:
Created Date:  2003-05-08     Completed Date:  2003-12-17     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  406-10     Citation Subset:  IM    
Departments of Internal Medicine and Cardiology, Osaka City University School of Medicine, Osaka, Japan.
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MeSH Terms
Adrenergic beta-Agonists / diagnostic use
Aged, 80 and over
Angina Pectoris / physiopathology,  ultrasonography
Coronary Angiography
Dobutamine / diagnostic use*
Echocardiography / drug effects,  methods*
Exercise Test / methods*
Heart / physiopathology*
Hemodynamics / drug effects
Middle Aged
Myocardial Ischemia / physiopathology*,  ultrasonography
Patient Selection
Reproducibility of Results
Reg. No./Substance:
0/Adrenergic beta-Agonists; 34368-04-2/Dobutamine

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