Dobutamine Stress Echocardiography Predicts Left Ventricular Remodeling After Acute Myocardial Infarction☆,☆☆
Section snippets
Patient Selection and Entry Criteria
Male and female patients hospitalized for their first MI who underwent dobutamine stress echocardiography (DSE) within 2 to 7 days of admission were identified for the study. Inclusion criteria were normal sinus rhythm, documentation to support acute transmural MIs, (ST-segment elevation ≥2 mm above baseline in at least 2 contiguous electrocardiography [ECG] leads), development of new abnormal Q-wave and serial changes in cardiac isoenzymes, a DSE within 7 days of infarction, and a follow-up
RESULTS
A total of 30 patients with a follow-up 2.6 ± 0.9 years met the inclusion criteria and formed the study group. LV remodeling occurred in 17 of 30 patients (Figure 1).
Table 1 compares clinical data of patients with and without LV remodeling.
Clinical data Remodel (n = 17) No change (n = 13) Age (y) 65 ± 14 50 ± 10* Anterior MI 59% (10) 38% (5)† Sex (female) 18% (3) 31% (4) Peak CK (IU/mL) 2785
DISCUSSION
Our data demonstrate that after MI occurs, DSE can accurately predict LV remodeling by its ability to estimate infarct size and detect viability or nonviability of the infarct zone. The presence of large infarct, wall motion abnormality in 4 or more segments at low-dose dobutamine, nonviability of the infarct zone, and age >60 years predicted subsequent remodeling in 99% of patients. Viability of the infarct zone was a strong negative predictor of LV remodeling.
Several previous studies have
Acknowledgements
The authors appreciate the technical assistance of Tammy Smith and Debbie Bambulas and the secretarial assistance of Diane Lawton and Cathy Watson.
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