Correlation of myocardial histologic changes in hibernating myocardium with dobutamine stress echocardiographic findings☆,☆☆,★
Section snippets
Background
Available data suggest that dobutamine stress echocardiography (DSE) is useful for the detection of “hibernating” myocardium (resting contractile dysfunction reversed by revascularization).1, 2, 3 The detection of contractile reserve by inotropic stimulation is the basis for the use of DSE to predict postrevascularization functional recovery. In patients with restriction of coronary blood flow at rest, the administration of dobutamine may cause a deterioration in myocardial dysfunction even at
General
Patients with known coronary artery disease (single, double, or triple vessel) with an occlusion or severe stenosis (>70%) on cine coronary angiography of the left anterior descending coronary artery and a corresponding wall motion abnormality on contrast ventriculography and transthoracic echocardiography (septum, anterior septum, anterior wall, and apex of the left ventricle) undergoing coronary artery bypass grafting were eligible for study. Patients with a myocardial infarct in the
Patient demographic and clinical features
Patient demographic and clinical features are outlined in Table I.
DVD, Double vessel disease; TVD, triple vessel disease; NYHA, New York Heart Association; MI, myocardialPatient JK SOR HM HCY HCN MW JG JB Age (yr) 56 67 75 56 61 62 57 64 Vessels disease DVD DVD DVD DVD DVD DVD TVD TVD Ejection fraction % 25 20 40 35 30 30 15 45 Dyspnea class (CCS) 2 4 3 3 2 3 2 2 Angina class (NYHA) 3 2 4 3 4 3 4 3 History MI No Yes Yes No No Yes Yes Yes Anterior Q waves Yes No No No No No Yes Yes
Diagnostic accuracy of DSE for detection of hibernating myocardium
Myocardial segments demonstrating improvement in wall motion with low-dose dobutamine infusion have statistically significant less fibrosis than segments failing to demonstrate such reserve (Table II). This result confirms the theory that the response of dysfunctional myocardium is critically dependent on the quantity of residual contractile apparatus. Percent fibrosis was significantly less in the segments demonstrating improvement after revascularization (Table III). Therefore with the use of
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Cited by (0)
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From the Departments of aCardiology, bPathology, and cCardiac Surgery, Mater Misericordiae Hospital, D7.
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Reprint requests: Terence Hennessy, MD, Transplant Unit, Regional Cardiac Unit, Papworth Hospital, Cambridge, CB3 8RE, England.
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