Coronary Artery DiseaseDobutamine stress echocardiography at 7.5 μg/kg/min using color tissue Doppler imaging M-mode safely predicts reversible dysfunction early after reperfusion in patients with acute myocardial infarction
Section snippets
Subjects
Fifty-six consecutive patients undergoing primary coronary angioplasty for a first acute myocardial infarction were admitted to our hospital. The diagnosis of acute myocardial infarction was made on the basis of prolonged chest pain, a greater than threefold increase in serum creatine kinase, ST elevation in ≥2 electrocardiographic leads, and wall motion abnormalities on baseline 2-dimensional echocardiography. Three patients were excluded from the study because of technical difficulties
Hemodynamic data
Hemodynamic measurements during DSE were as follows: heart rate at rest, 70 ± 9 beats/min, rate with 7.5 μg/kg/min of dobutamine, 75 ± 9 beats/min (p <0.01 vs rest), and rate with 10 μg/kg/min of dobutamine, 86 ± 10 beats/min (p <0.05 vs rest, p <0.01 vs 7.5-μg/kg/min dose), resting blood pressure, 118 ± 13 mm Hg, blood pressure with 7.5 μg/kg/min of dobutamine, 128 ± 14 mm Hg (p <0.01 vs rest), and blood pressure with 10 μg/kg/min of dobutamine, 138 ± 18 mm Hg (p <0.01 vs rest, p <0.01 vs
Discussion
Color TDI M-mode enables objective and quantitative assessment of ventricular wall motion and gives additional information for detecting reversible dysfunction in DSE. Moreover, improvement of sensitivity for detecting reversible dysfunction at a lower dose (7.5 μg/kg/min) of dobutamine has an excellent safety profile for DSE.
The combination of conventional and TDI data was superior to either method alone (Table I). Thus, TDI-M is useful to supplement the conventional data.
The reasons why color
Acknowledgements
We are indebted to Sinichi Fujita and Yuji Masaki for their assistance in collecting the clinical data, and we gratefully thank Nelson B. Schiller, MD, and Rita F. Redberg, MD, for their invaluable advice.
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Clinical Applications of Strain Rate Imaging
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2003, American Journal of CardiologyCitation Excerpt :Similarly, a significant increment in global long-axis function is concordant with the radial thickening response to low-dose dobutamine in viable segments.22 A more regional quantitative assessment of viability has been proposed in recent studies,23–25 and these approaches have been validated against single-photon26 and positron tomography.24,27 The prediction of myocardial recovery during follow-up echocardiography has been accomplished by identifying increments in segmental velocity during low-dose dobutamine using pulse-wave tissue Doppler.23,24
Strain rate measurement by Doppler echocardiography allows improved assessment of myocardial viability in patients with depressed left ventricular function
2002, Journal of the American College of CardiologyCitation Excerpt :Several solutions have been suggested to circumvent these difficulties. Nishino et al. (18)applied M-mode TDI, in combination with dobutamine stimulation, in the post-myocardial infarction setting and reported a high sensitivity for the prediction of reversible dysfunction. They determined a velocity gradient between the endocardium and epicardium both at rest and during dobutamine stress to evaluate the functional reserve.
Early systolic mitral annular motion velocities responses to dobutamine infusion predict myocardial viability in patients with previous myocardial infarction
2002, American Heart JournalCitation Excerpt :The development of TDI14-17 facilitated the quantitative analysis of regional LV wall motion abnormalities. Recently, many studies have reported that myocardial viability can be evaluated with pulsed TDI27-29 or color-coded TDI30-35 during dobutamine infusion in patients with MI. The clinical usefulness of pulsed TDI is, in part, based on its excellent time resolution, which is relatively independent from the frame rate, and the simplicity of image acquisition.36,37
Overview of stress echocardiography: Uses, advantages, and limitations
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