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Early prediction of improvement in ejection fraction after acute myocardial infarction using low dose dobutamine echocardiography
  1. F Nijland1,
  2. O Kamp1,
  3. P M J Verhorst1,
  4. W G de Voogt2,
  5. C A Visser1
  1. 1Department of Cardiology and Institute for Cardiovascular Research, VU Medical Centre, Amsterdam, Netherlands
  2. 2Department of Cardiology, Sint Lucas-Andreas Hospital, Amsterdam
  1. Correspondence to:
    Dr Francisca Nijland, VU Medical Centre, Department of Cardiology, PO Box 7057, 1007 MB Amsterdam, Netherlands;


Objective: To evaluate the relation between changes in ejection fraction during the first three months after acute myocardial infarction and myocardial viability.

Patients: Myocardial viability was assessed using low dose dobutamine echocardiography in 107 patients at mean (SD) 3 (1) days after acute myocardial infarction. Cross sectional echocardiography was repeated three months later. Left ventricular volumes and ejection fraction were determined from apical views using the Simpson biplane formula.

Results: In patients with viability, ejection fraction increased by 4.4 (4.3)%; in patients without viability it remained unchanged (0.04 (3.6)%; p < 0.001). A ≥ 5% increase in ejection fraction was present in 21 of 107 patients (20%). Receiver operating characteristic analysis showed that myocardial viability in ≥ 2 segments predicted this increase in ejection fraction with a sensitivity of 81% and a specificity of 65%. Multivariate logistic regression analysis was used to define which clinical and echocardiographic variables were related to ≥ 5% improvement in ejection fraction. Myocardial viability, non-Q wave infarction, and anterior infarction all emerged as independent predictors, myocardial viability being the best (χ2 = 14.5; p = 0.0001). Using the regression equation, the probability of ≥ 5% improvement in ejection fraction for patients with a non-Q wave anterior infarct with viability was 73%, and for patients with a Q wave inferior infarct without viability, only 2%.

Conclusions: Myocardial viability after acute myocardial infarction is the single best predictor of improvement in ejection fraction. In combination with infarct location and Q wave presence, the probability of ≥ 5% improvement can be estimated in individual patients at the bedside.

  • echocardiography
  • myocardial infarction
  • myocardial viability

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