Article Text

PDF
Changes in the Doppler myocardial performance index during dobutamine echocardiography: association with neurohormonal activation and prognosis after acute myocardial infarction
  1. B Nørager1,
  2. M Husic1,
  3. J E Møller2,
  4. A Bo Hansen3,
  5. P A Pellikka4,
  6. K Egstrup1
  1. 1Department of Medical Research, Svendborg Hospital, Svendborg, Denmark
  2. 2Department of Cardiology, Odense University Hospital, Odense, Denmark
  3. 3Department of Clinical Chemistry, Odense University Hospital, Odense, Denmark
  4. 4Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to:
    Dr Betina Nørager
    Springbanen 27, 2nd Floor, 3rd Apartment, 2820 Gentofte, Denmark; bnorager{at}mail.dk

Abstract

Objectives: To test whether an increase in Doppler myocardial performance index (MPI) during dobutamine stress echocardiography, reflecting deterioration of overall left ventricular function, is associated with increased N-terminal pro-brain natriuretic peptide (NT-pro-BNP) concentration and provides prognostic information beyond conventional systolic wall motion analysis after acute myocardial infarction (AMI).

Design: Prospective, observational study.

Methods: Dobutamine–atropine stress echocardiography (DASE) and NT-pro-BNP were assessed five days after AMI in 109 consecutive patients. MPI was measured at rest and at low-dose (10 μg/kg/min) and peak dobutamine infusion (⩽ 40 μg/kg/min with or without atropine).

Main outcome measures: End point was a composite of cardiac death or readmission for heart failure or reinfarction.

Results: In 35 patients (32%), MPI increased at low-dose DASE. This was associated with higher NT-pro-BNP concentrations (β  =  0.30, p  =  0.004). During a mean follow up of 27 (SD 7) months, 8 patients died of cardiac causes and 15 patients were readmitted for heart failure or reinfarction. On Cox regression analysis, an increase in MPI at low-dose DASE (p  =  0.02) was an independent predictor of cardiac events. In contrast, traditional wall motion analysis during DASE provided no additional prognostic information.

Conclusions: An increase in MPI at low-dose DASE, reflecting early deterioration of overall left ventricular function, is associated with raised NT-pro-BNP concentration and provides prognostic information beyond conventional stress echocardiographic data after AMI.

  • AMI, acute myocardial infarction
  • BNP, brain natriuretic peptide
  • DASE, dobutamine–atropine stress echocardiography
  • LV, left ventricular
  • MPI, myocardial performance index
  • NT-pro-BNP, N-terminal pro-brain natriuretic peptide
  • dobutamine stress echocardiography
  • myocardial infarction
  • Doppler echocardiography
  • N-terminal pro-brain natriuretic peptide
  • prognosis

Statistics from Altmetric.com

Footnotes

  • Published Online First 30 December 2005

  • The study was supported by a grant from the Danish Heart Foundation.

  • Competing interests: None declared.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.