Document Detail

Usefulness of the ejection fraction response to dobutamine infusion in predicting functional recovery after coronary artery bypass grafting in patients with left ventricular dysfunction.
MedLine Citation:
PMID:  10856389     Owner:  NLM     Status:  MEDLINE    
Quantification of dysfunctional but viable myocardium has high prognostic value for improvement of left ventricular (LV) function after coronary artery bypass grafting (CABG). Dobutamine stress echocardiography (DSE) can assess viable myocardium by segmental wall motion changes during stress. However, analysis of wall motion is subjective with only moderate interinstitutional agreement (70%) and frequently overestimates functional improvement after CABG. In contrast, calculation of ejection fraction (EF) is less subjective and allows a more precise quantification of global contractile reserve. The aim of the study was to compare the prognostic value of EF response and segmental wall motion changes during DSE for the prediction of LV functional recovery after CABG. Forty patients underwent DSE before CABG. EF responses were assessed at rest, low-dose dobutamine, and at peak stress using the biplane disk method. Wall motion was scored using a 16-segment 5-point model. Resting radionuclide ventriculography (RNV-LVEF), performed before and 8 +/- 2 months after CABG, was used as an independent reference. Five patients were excluded because of perioperative infarction or poor echo images. In 11 of 35 patients, RNV-LVEF recovered >5%. Improvement in EF during dobutamine infusion predicted RNV-LVEF recovery after CABG significantly better than segmental wall motion changes (72% vs 53%, p = 0.03). A biphasic EF response (i.e., improvement in > or =10% at low dose and subsequent worsening at peak stress) had the highest predictive value (80%) for late functional recovery. In conclusion, EF response to dobutamine infusion was superior to segmental wall motion changes in predicting RNV-LVEF recovery after CABG.
G Rocchi; D Poldermans; J J Bax; R Rambaldi; E Boersma; A Elhendy; P van der Meer; W Vletter; J R Roelandt
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The American journal of cardiology     Volume:  85     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2000 Jun 
Date Detail:
Created Date:  2000-08-04     Completed Date:  2000-08-04     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1440-4     Citation Subset:  AIM; IM    
Erasmus Medical Center, Rotterdam, The Netherlands.
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MeSH Terms
Coronary Artery Bypass*
Coronary Disease / complications,  physiopathology,  surgery
Dobutamine / diagnostic use*,  pharmacology
Middle Aged
Myocardial Contraction
Radionuclide Ventriculography
Stroke Volume / drug effects*
Treatment Outcome
Ventricular Dysfunction, Left / etiology,  physiopathology*,  surgery
Reg. No./Substance:

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