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In-hospital and long-term prognostic value of viable myocardium detected by dobutamine echocardiography early after acute myocardial infarction and its relation to indicators of left ventricular systolic dysfunction

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Abstract

The prognostic value of myocardial viability early after acute myocardial infarction (AMI) is still controversial, depending on the patient under study and the outcome end point considered. Furthermore, the relative prognostic importance of viability compared with indicators of systolic left ventricular (LV) dysfunction is not known. One hundred thirty-eight patients were studied with low-dose dobutamine echocardiography 3 ± 1 days after AMI. Patients were divided in 2 groups based on presence (n = 55) or absence (n = 83) of myocardial viability and followed up for in-hospital and late cardiac events. During hospitalization, myocardial viability was the only independent predictor for recurrent ischemic events (chi-square 5.0, p = 0.025). End-systolic volume index and ejection fraction were both independent predictors of the occurrence of heart failure, whereas gender and end-systolic volume index emerged as independent predictors of hard cardiac events (death and sustained ventricular tachycardia). After hospital discharge, patients were followed for 19 ± 7 months. Again, myocardial viability emerged as the only independent predictor of unstable angina (chi-square 7.7, p = 0.005). Age, hypertension, and ejection fraction were the most important independent predictors of hospitalization for heart failure, whereas ejection fraction was the only independent predictor of hard cardiac events. Presence of myocardial viability early after AMI is the single best predictor of recurrent in-hospital ischemic events and unstable angina after discharge. With respect to hard cardiac events and occurrence of heart failure, indicators of LV systolic dysfunction have a higher prognostic value than presence of myocardial viability.

Section snippets

Patient population

The study population consisted of 138 consecutive patients (<76 years old) with AMI admitted to the Coronary Care Unit of the Free University Hospital and the Sint Lucas-Andreas Hospital. Myocardial infarction was documented by a history of typical chest pain, ST-segment elevation in 2 contiguous leads and a transient increase in creatine kinase more than twice the upper limit of normal. Patients treated with and without thrombolytic therapy or primary coronary angioplasty, with first or

Patient characteristics

On the basis of the results of the dobutamine study, patients were divided into 2 groups: 55 patients with viability and 83 patients without viability. Baseline characteristics of both groups are shown in Table 1.

In-hospital events

No complications occurred during low-dose dobutamine echocardiography. Patients were hospitalized for 13 ± 7 days (range 4 to 49). The hospital stay for uncomplicated AMI was 11 ± 5 days. After elimination of patients who had bypass surgery or coronary angioplasty, which might

Discussion

To date, several retrospective studies have evaluated the prognostic implications of myocardial viability, detected by positron emission tomography or dobutamine stress echocardiography, in patients with chronic coronary artery disease and moderate to severe LV dysfunction.13, 14, 15, 16 In general, these studies have shown that presence of viable myocardium, if left unrevascularized, leads to a greater number of events14, 16 and cardiac death.13, 14, 15 The prognostic benefit of

Acknowledgements

We appreciate the great support from our technicians Irma Bekkering, Sylvia Bruinzeel, Anja Folkers and Beatrix Willemsen.

References (24)

  • Risk stratification and survival after myocardial infarction

    N Engl J Med

    (1983)
  • A. Volpi et al.

    Determinants of 6-month mortality in survivors of myocardial infarction after thrombolysis. Results of the GISSI-2 data base

    Circulation

    (1983)
  • H.D. White et al.

    Left ventricular end-systolic volume as the major determinant of survival after recovery from myocardial infarction

    Circulation

    (1983)
  • M. St John Sutton et al.

    Quantitative two-dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effect of Captopril

    Circulation

    (1983)
  • M.E. Carlos et al.

    Dobutamine stress echocardiography for risk stratification after myocardial infarction

    Circulation

    (1983)
  • E. Picano et al.

    Prognostic value of myocardial viability in medically treated patients with global left ventricular dysfunction early after an acute uncomplicated myocardial infarction. A dobutamine stress echocardiographic study

    Circulation

    (1983)
  • R. Sicari et al.

    Prognostic value of dobutamine-atropine stress echocardiography early after acute myocardial infarction

    J Am Coll Cardiol

    (1983)
  • M. Previtali et al.

    Prognostic value of myocardial viability and ischemia detected by dobutamine stress echocardiography early after acute myocardial infarction treated with thrombolysis

    J Am Coll Cardiol

    (1983)
  • J.M. Huitink et al.

    Predictive value of planar 18F-fluorodeoxyglucose imaging for cardiac events in patients after acute myocardial infarction

    Am J Cardiol

    (1983)
  • G. Kan et al.

    Short and long term predictive value of admission wall motion score in acute myocardial infarctiona cross sectional echocardiographic study of 345 patients

    Br Heart J

    (1983)
  • N. Schiller et al.

    Recommendations for quantification of the left ventricle by two-dimensional echocardiographyAmerican Society of Echocardiography Subcommittee on Standards

    J Am Soc Echocardiogr

    (1983)
  • J.H. Bosch et al.

    Evaluation of a semiautomatic contour detection approach in sequences of short-axis two-dimensional echocardiographic images

    J Am Soc Echocardiogr

    (1983)
  • Cited by (0)

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