Usefulness of quantitative echocardiographic techniques to predict recovery of regional and global left ventricular function after acute myocardial infarction

• Published in: The American journal of cardiology 2003-02, Vol.91 (4), p.391-396
• Main Authors: Cain, Peter, Khoury, Vincent, Short, Leanne, Marwick, Thomas H.
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology; Cardiotonic Agents; Cardiovascular system; Coronary Artery Bypass; Coronary Circulation; Dobutamine; Echocardiography, Stress - methods; Echocardiography, Stress - standards; Echocardiography, Three-Dimensional - methods; Echocardiography, Three-Dimensional - standards; Feasibility Studies; Female; Follow-Up Studies; Heart attacks; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Myocardial Infarction - complications; Myocardial Infarction - therapy; Observer Variation; Predictive Value of Tests; Prognosis; Recovery of Function; ROC Curve; Stroke Volume; Treatment Outcome; Ultrasonic investigative techniques; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(02)03231-9

The left ventricular response to dobutamine may be quantified using tissue Doppler measurement of myocardial velocity or displacement or 3-dimensional echocardiography to measure ventricular volume and ejection fraction. This study sought to explore the accuracy of these methods for predicting segmental and global responses to therapy. Standard dobutamine and 3-dimensional echocardiography were performed in 92 consecutive patients with abnormal left ventricular function at rest. Recovery of function was defined by comparison with follow-up echocardiography at rest 5 months later. Segments that showed improved regional function at follow-up showed a higher increment in peak tissue Doppler velocity with dobutamine therapy than in nonviable segments (1.2 ± 0.4 vs 0.3 ± 0.2 cm/s, p = 0.001). Similarly, patients who showed a >5% improvement of ejection fraction at follow-up showed a greater displacement response to dobutamine (6.9 ± 3.2 vs 2.1 ± 2.3 mm, p = 0.001), as well as a higher rate of ejection fraction response to dobutamine (9 ± 3% vs 2 ± 2%, p = 0.001). The optimal cutoff values for predicting subsequent recovery of function at rest were an increment of peak velocity >1 cm/s, >5 mm of displacement, and a >5% improvement of ejection fraction with low-dose dobutamine.