Circulation, Vol 88, 430-436, Copyright © 1993 by American Heart Association
CG Cigarroa, CR deFilippi, ME Brickner, LG Alvarez, MA Wait and PA Grayburn
BACKGROUND. The identification of hibernating myocardium is important in
selecting patients who will benefit from coronary revascularization. This
study was performed to determine whether dobutamine stress echocardiography
(DSE) could identify hibernating myocardium and predict improvement in
regional systolic wall thickening after revascularization. METHODS AND
RESULTS. DSE was performed in 49 consecutive patients with multivessel
coronary disease and depressed left ventricular function. Contractile
reverse during DSE was defined by the presence of two criteria: (1)
improved systolic wall thickening in at least two adjacent abnormal
segments and (2) > or = 20% improvement in regional wall thickening
score. Postoperative echocardiograms were evaluated for improved regional
wall thickening in 25 patients at least 4 weeks after successful coronary
revascularization. All studies were read in blinded fashion. Contractile
reserve during DSE was present in 24 (49%) of 49 patients. The presence or
absence of contractile reserve on preoperative DSE predicted recovery of
ventricular function in the 25 patients who underwent successful
revascularization. Thus, 9 of 11 patients with contractile reserve had
improved systolic wall thickening after revascularization (hibernating
myocardium), whereas 12 of 14 patients without contractile reserve did not
improve (P = .003). CONCLUSIONS. Dobutamine stress echocardiography
provides a simple, cost-effective, and widely available method of
identifying hibernating myocardium and predicting improvement in regional
left ventricular wall thickening after coronary revascularization. This
technique may be clinically valuable in the selection of patients for
coronary revascularization.
ARTICLES
Dobutamine stress echocardiography identifies hibernating myocardium and predicts recovery of left ventricular function after coronary revascularization
Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas.
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