Dobutamine Stress Echocardiography Predicts Left Ventricular Remodeling After Acute Myocardial Infarction,☆☆

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Abstract

Background and Objectives: Left ventricular (LV) remodeling after acute myocardial infarction (MI) is strongly related to infarct size. The contribution of viability in the infarct zone and the presence of multivessel disease remains unknown. Because dobutamine stress echocardiography (DSE) can estimate infarct size and detect myocardial viability and multivessel disease, we postulated that DSE can accurately predict LV remodeling after acute MI. Methods: To test this hypothesis, 30 patients age 59 ± 15 years, 21 men, 14 with anterior MI, underwent multistage DSE (low dose, 5 to 10 μg, and peak dose) during the first week after MI occurred. Follow-up echocardiography was performed at ≥1 year. LV remodeling (2 SD increase in LV volume) occurred in 17 of 30 patients. Remodeling occurred in 12 (92%) of 13 patients with large nonviable infarct and in 1 (13%) of 8 patients with large viable infarct (P < .001). Univariate predictors of LV remodeling were baseline ejection infarct (P < .01), infarct size (number of akinetic segments at low dose P < .01), age (P < .05), and multivessel coronary disease (P < .01). The only multivariate predictor of remodeling was infarct size. Viability of infarct zone was a negative predictor of LV remodeling. Conclusion: DSE performed during the first week after acute MI predicts subsequent LV remodeling. Infarct size, nonviability of the infarct zone, and age are independent predictors of LV remodeling. Myocardial viability is a strong negative predictor of LV remodeling. (J Am Soc Echocardiogr 1999;12:777-84.)

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).

. Pie graph shows that remodeling occurred in 17 of 20 patients at 2.6 ± 0.9 years.

Table 1 compares clinical data of patients with and without LV remodeling.

. Clinical data according to outcome

Clinical dataRemodel (n = 17)No change (n = 13)
Age (y)65 ± 1450 ± 10*
Anterior MI59% (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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