Prognostic interaction between viability and residual myocardial ischemia by dobutamine stress echocardiography in patients with acute myocardial infarction and mildly impaired left ventricular function
Section snippets
Study population
The initial study population consisted of 545 consecutive patients admitted to a coronary care unit because of first AMI documented by typical chest pain lasting >30 minutes, elevated creatine kinase and MB fraction, and electrocardiographic changes. Exclusion criteria were: (1) complicated infarction (overt heart failure, complex arrhythmia, and early recurrence of myocardial ischemia, n = 54), (2) prior infarction (n = 18), (3) ejection fraction <40% (n = 52), and (4) technically inadequate
Results
Clinical and echocardiographic characteristics of the study population are listed in Table 1. Two major adverse reactions were observed: 1 ventricular fibrillation that occurred 10 minutes after halting dobutamine infusion, which was effectively reverted by electrical defibrillation, and 1 sustained ventricular tachycardia at peak infusion. Premature termination of the test because of intolerable side effects was necessary in 2 patients.
Discussion
Because the beneficial effect of functional recovery on survival is expected to be critically correlated with the extent of LV dysfunction, the clinical relevance of myocardial viability has been mostly evaluated in patients with impaired LV function.2, 3, 6 However, this study demonstrates an unfavorable prognostic impact of the combination of myocardial ischemia and viability in patients with AMI and mildly impaired LV function. Of note, myocardial ischemia was prognostically significant only
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