Document Detail


Prognostic value of myocardial viability recognized by low-dose dobutamine echocardiography in chronic ischemic left ventricular dysfunction.
MedLine Citation:
PMID:  14636900     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This study assesses the prognostic value of myocardial viability recognized as a contractile response to inotropic stimulation in patients with left ventricular (LV) dysfunction in a large-scale prospective, multicenter, observational study. Four hundred twenty-five patients (mean age 61 +/- 10 years) with angiographically proven coronary artery disease, previous (>3 months) myocardial infarction, and severe LV dysfunction (ejection fraction <35%; mean 28 +/- 6%) were enrolled in the study. Each patient underwent low-dose dobutamine echocardiography (up to 10 microg/kg/min). Myocardial viability was identified as a rest-stress variation (Delta) in the wall motion score index (WMSI), in which each segment was scored from 1 = normal to 4 = dyskinetic in a 16-segment model of the left ventricle. Myocardial viability was identified as an improvement of >/=0.40 in WMSI. All patients were followed for a median of 3.1 years. One hundred eighty-eight were revascularized either by coronary artery bypass grafting (n = 118) or coronary angioplasty (n = 70). The only end point analyzed was cardiac death. In the revascularized group, cardiac death occurred in 4 of the 52 patients with and in 37 of the 136 patients without myocardial viability (7.7% vs 27.2%, p <0.003). Kaplan-Meier survival estimates showed a better outcome for those patients with compared to patients without myocardial viability who underwent coronary revascularization (90.1% vs 62%, p <0.0078). Thus, in severe LV ischemic dysfunction, myocardial viability by low-dose dobutamine echocardiography is associated with improved survival in revascularized patients.
Authors:
Rosa Sicari; Eugenio Picano; Lauro Cortigiani; Adrian C Borges; Albert Varga; Caterina Palagi; Riccardo Bigi; Roberta Rossini; Emilio Pasanisi;
Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  The American journal of cardiology     Volume:  92     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-11-25     Completed Date:  2004-01-21     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1263-6     Citation Subset:  AIM; IM    
Affiliation:
CNR, Institute of Clinical Physiology, Pisa, Italy. rosas@ifc.cnr.it
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MeSH Terms
Descriptor/Qualifier:
Cardiotonic Agents / diagnostic use*
Chronic Disease
Dobutamine / diagnostic use*
Echocardiography / methods*
Female
Humans
Male
Middle Aged
Myocardial Ischemia / physiopathology*,  ultrasonography*
Myocardium / pathology*
Predictive Value of Tests
Prognosis
Proportional Hazards Models
Prospective Studies
Survival Rate
Ventricular Dysfunction, Left / physiopathology*,  ultrasonography*
Chemical
Reg. No./Substance:
0/Cardiotonic Agents; 34368-04-2/Dobutamine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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