Circulation, Vol 90, 1502-1512, Copyright © 1994 by American Heart Association
J Sklenar, S Ismail, FS Villanueva, NC Goodman, WP Glasheen and S Kaul
BACKGROUND: Although dobutamine echocardiography is being increasingly used
to determine the presence of viable myocardium in patients who have
undergone successful reperfusion therapy, the physiological basis for such
a use has not been clearly defined. Because postischemic myocardium has
contractile reserve, we hypothesized that the absolute degree of wall
thickening induced by dobutamine during reflow would be directly related to
the amount of myocardium that has escaped necrosis. METHODS AND RESULTS:
Three groups of 12 dogs each were studied at baseline and during 2 to 6
hours of coronary artery occlusion and 15 minutes of reperfusion. In group
1 dogs, which did not receive dobutamine during any of these stages,
percent wall thickening at these stages was 32 +/- 6%, -2 +/- 6%, and 5 +/-
6%, respectively, and there was no relation between infarct size and
percent wall thickening during reflow (r = .20, P = .51). In group 2 dogs,
which received 15 micrograms/kg per minute of dobutamine at all stages,
wall thickening at these stages was 40 +/- 8%, 0 +/- 8%, and 19 +/- 10%,
respectively, and a good inverse correlation was noted between infarct size
and percent wall thickening during reflow (r = -.81, P = .001). In group 3
dogs, in which wall thickening during reflow was measured both before and
during infusion of 15 micrograms/kg per minute of dobutamine, it was 5 +/-
8% and 18 +/- 14%, respectively, at these stages. Although the correlation
between infarct size and percent wall thickening was poor in the absence of
dobutamine (r = .36, P = .26), an excellent inverse correlation was noted
between the two in the presence of dobutamine (r = -.93, P < .001). A
fair inverse correlation was also noted between infarct size and the
absolute change in wall thickening induced by dobutamine (r = -.72, P <
.01). Maximal wall thickening was noted at a dobutamine dose of 15
micrograms/kg per minute, and lower doses did not elicit thickening in the
presence of larger infarcts despite the presence of viable myocardium.
CONCLUSIONS: When myocardial necrosis coexists with post-ischemic
myocardial dysfunction and no residual coronary stenosis, the absolute
degree of wall thickening during dobutamine can be used to determine the
extent of myocardium that has escaped necrosis. The dose of dobutamine
needed to elicit maximal thickening of the postischemic myocardium is
related to the amount of myocardial necrosis.
ARTICLES
Dobutamine echocardiography for determining the extent of myocardial salvage after reperfusion. An experimental evaluation
Cardiovascular Division, University of Virginia, Charlottesville.
This article has been cited by other articles:
 |
|
 |
|
  F. Xie, S. Dodla, E. O'Leary, and T. R. Porter Detection of subendocardial ischemia in the left anterior descending coronary artery territory with real-time myocardial contrast echocardiography during dobutamine stress echocardiography. J. Am. Coll. Cardiol. Img., May 1, 2008; 1(3): 271 - 278. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. N. Mazzadi, M. F. Janier, B. Brossier, X. Andre-Fouet, E. McFadden, D. Revel, and P. Croisille Dobutamine-tagged MRI for inotropic reserve assessment in severe CAD: relationship with PET findings Am J Physiol Heart Circ Physiol, May 1, 2004; 286(5): H1946 - H1953. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H.-K. Yip, C.-J. Wu, H.-W. Chang, Y.-K. Hsieh, C.-Y. Fang, S.-M. Chen, and M.-C. Chen Impact of Tirofiban on Angiographic Morphologic Features of High-Burden Thrombus Formation During Direct Percutaneous Coronary Intervention and Short-term Outcomes Chest, September 1, 2003; 124(3): 962 - 968. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Mahrholdt, A. Wagner, M. Parker, M. Regenfus, D. S. Fieno, R. O. Bonow, R. J. Kim, and R. M. Judd Relationship of contractile function to transmural extent of infarction in patients with chronic coronary artery disease J. Am. Coll. Cardiol., August 6, 2003; 42(3): 505 - 512. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Menasche, A. A. Hagege, J.-T. Vilquin, M. Desnos, E. Abergel, B. Pouzet, A. Bel, S. Sarateanu, M. Scorsin, K. Schwartz, et al. Autologous skeletal myoblast transplantation for severe postinfarction left ventricular dysfunction J. Am. Coll. Cardiol., April 2, 2003; 41(7): 1078 - 1083. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H.-K. Yip, M.-C. Chen, H.-W. Chang, C.-L. Hang, Y.-K. Hsieh, C.-Y. Fang, and C.-J. Wu Angiographic Morphologic Features of Infarct-Related Arteries and Timely Reperfusion in Acute Myocardial Infarction: Predictors of Slow-Flow and No-Reflow Phenomenon Chest, October 1, 2002; 122(4): 1322 - 1332. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Andrassy, M Zielinska, R Busch, A Schomig, and C Firschke Myocardial blood volume and the amount of viable myocardium early after mechanical reperfusion of acute myocardial infarction: prospective study using venous contrast echocardiography Heart, April 1, 2002; 87(4): 350 - 355. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F Piscione, P Perrone-Filardi, G De Luca, M Prastaro, C Indolfi, P Golino, S Dellegrottaglie, and M Chiariello Low dose dobutamine echocardiography for predicting functional recovery after coronary revascularisation Heart, December 1, 2001; 86(6): 679 - 686. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Pislaru, C. J. Bruce, M. Belohlavek, J. B. Seward, and J. F. Greenleaf Intracardiac measurement of pre-ejection myocardial velocities estimates the transmural extent of viable myocardium early after reperfusion in acute myocardial infarction J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1748 - 1756. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Takehana, M. Ruiz, F. D. Petruzella, D. D. Watson, G. A. Beller, and D. K. Glover Response to incremental doses of dobutamine early after reperfusion is predictive of the degree of myocardial salvage in dogs with experimental acute myocardial infarction J. Am. Coll. Cardiol., June 1, 2000; 35(7): 1960 - 1968. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R J Trent, G D Waiter, G S Hillis, F I McKiddie, T W Redpath, and S Walton Dobutamine magnetic resonance imaging as a predictor of myocardial functional recovery after revascularisation Heart, January 1, 2000; 83(1): 40 - 46. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R Senior and A Lahiri Dobutamine echocardiography predicts functional outcome after revascularisation in patients with dysfunctional myocardium irrespective of the perfusion pattern on resting thallium-201 imaging Heart, December 1, 1999; 82(6): 668 - 673. [Abstract] [Full Text]
|
|
|
|
|
|
E. P. Hoffer, W. Dewe, C. Celentano, and L. A. Pierard Low-level exercise echocardiography detects contractile reserve and predicts reversible dysfunction after acute myocardial infarction: Comparison with low-dose dobutamine echocardiography J. Am. Coll. Cardiol., October 1, 1999; 34(4): 989 - 997. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Colonna, R. Montisci, L. Galiuto, L. Meloni, and S. Iliceto Effects of acute ischaemia on intramyocardial contraction heterogeneity; new ultrasound technologies to study an old phenomenon Eur. Heart J., March 1, 1999; 20(5): 327 - 337. [PDF]
|
|
|
|
 |
|
 G. Geskin, C. M. Kramer, W. J. Rogers, T. M. Theobald, D. Pakstis, Y.-L. Hu, and N. Reichek Quantitative Assessment of Myocardial Viability After Infarction by Dobutamine Magnetic Resonance Tagging Circulation, July 21, 1998; 98(3): 217 - 223. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. Meza, S. Ramee, T. Collins, D. Stapleton, R. V. Milani, J. P. Murgo, and J. Cheirif Knowledge of Perfusion and Contractile Reserve Improves the Predictive Value of Recovery of Regional Myocardial Function Postrevascularization : A Study Using the Combination of Myocardial Contrast Echocardiography and Dobutamine Echocardiography Circulation, November 18, 1997; 96(10): 3459 - 3465. [Abstract] [Full Text]
|
|
|
|
 |
|
 K. Bouki and A. Kranidis In Response: Reply to Drs. Pontillo and Capezzuto Angiology, October 1, 1997; 48(10): 932 - 932. [PDF]
|
|
|
|
|
|
A. Cohen, C. Chauvel, B. Benhalima, P. Guyon, I. Desert, J. Valty, and A. Cohen Is Dobutamine Stress Echocardiography Useful for Noninvasive Differentiation of Ischemic from Idiopathic Dilated Cardiomyopathy? Angiology, September 1, 1997; 48(9): 783 - 793. [Abstract] [PDF]
|
|
|
|
|
|
J.-L. J. Vanoverschelde, W. Wijns, M. Borgers, G. Heyndrickx, C. Depre, W. Flameng, and J. A. Melin Chronic Myocardial Hibernation in Humans: From Bedside to Bench Circulation, April 1, 1997; 95(7): 1961 - 1971. [Full Text]
|
|
|
|
|
|
U. Qureshi, S. F. Nagueh, I. Afridi, P. Vaduganathan, A. Blaustein, M. S. Verani, W. L. Winters, and W. A. Zoghbi Dobutamine Echocardiography and Quantitative Rest-Redistribution 201Tl Tomography in Myocardial Hibernation: Relation of Contractile Reserve to 201Tl Uptake and Comparative Prediction of Recovery of Function Circulation, February 4, 1997; 95(3): 626 - 635. [Abstract] [Full Text]
|
|
|
|
|
|
M. Arnese, J. H. Cornel, A. Salustri, A. P.W.M. Maat, A. Elhendy, A. E.M. Reijs, F. J. Ten Cate, D. Keane, A. H.M.M. Balk, J. R.T.C. Roelandt, et al. Prediction of Improvement of Regional Left Ventricular Function After Surgical Revascularization : A Comparison of Low-Dose Dobutamine Echocardiography With 201Tl Single-Photon Emission Computed Tomography Circulation, June 1, 1995; 91(11): 2748 - 2752. [Abstract] [Full Text]
|
|