Coronary Artery Disease
Diagnostic and Prognostic Value of Dipyridamole and Dobutamine Stress Echocardiography in Patients With Q-Wave Acute Myocardial Infarction

https://doi.org/10.1016/S0002-9149(97)00534-1Get rights and content

Abstract

The aim of this study was to compare dipyridamole and dobutamine stress echocardiography, performed early in patients with acute myocardial infarction (AMI) to evaluate residual ischemia, viability, and prognosis. Fifty patients (mean age 55 ± 9 years, 47 men, 3 women) with AMI, all treated with thrombolytic therapy, underwent standard dipyridamole and dobutamine tests, within the fifth day of the event. Wall motion score index and the 16 segments model were used to evaluate contractility. Forty-seven patients underwent coronary angiography within the tenth day of the event. The mean follow-up was 24 ± 12 months. No side effects occurred during both tests. Both dipyridamole and dobutamine tests were positive for ischemia, in 32 and 33 of 47 patients, respectively (sensitivity 73% and 75%; specificity 67% and 67%); these tests induced an improvement of contractility in 23 and 38 of 139 abnormal segments at baseline, respectively (sensitivity 52% and 86%; specificity 100% and 100%). Cardiac events occurred in 26 of 50 patients, 22 with a positive dipyridamole test and 21 with positive dobutamine test. Thus, both tests were feasible, safe, and useful to evaluate residual ischemia, viability, and prognosis. No significant differences were found in sensitivity and specificity between tests.

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Patients

Seventy consecutive patients admitted to the Coronary Care Unit for a first AMI from September 1991 to June 1992 and treated with thrombolytic therapy within 4 hours from the onset of symptoms were studied. Five patients with non-Q-wave AMI, 3 with unsatisfactory echocardiographic images, and 12 with clinically complicated course (continuing ischemia, left ventricular failure, shock or major arrhythmias) were excluded from the study. Fifty patients (47 men, 3 women, mean age 55 ± 9 years, range

Results

In all patients both tests were performed without major side effects.

Discussion

During recent years dipyridamole or dobutamine stress echocardiography has been increasingly used in patients with AMI. The present study compared the results of both pharmacologic tests performed in random order on different days very early after the onset of AMI. Our results are consistent with previous studies showing a similar accuracy of dipyridamole and dobutamine in identifying inducible ischemia1, 2, 3, 6, 7, 8, 9, 10, 12, 15 and viable myocardium.8, 9 Not surprisingly, the prognostic

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