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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M. F. Meza, S. Ramee, T. Collins, D. Stapleton, R. V. Milani, J. P. Murgo, and J. Cheirif Knowledge of Perfusion and Contractile Reserve Improves the Predictive Value of Recovery of Regional Myocardial Function Postrevascularization : A Study Using the Combination of Myocardial Contrast Echocardiography and Dobutamine Echocardiography Circulation, November 18, 1997; 96(10): 3459 - 3465. [Abstract] [Full Text]
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H. H. Lee, V. G. Davila-Roman, P. A. Ludbrook, M. Courtois, J. F. Walsh, D. A. Delano, P. J. Rubin, and R. J. Gropler Dependency of Contractile Reserve on Myocardial Blood Flow : Implications for the Assessment of Myocardial Viability With Dobutamine Stress Echocardiography Circulation, November 4, 1997; 96(9): 2884 - 2891. [Abstract] [Full Text]
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A. Elsasser, M. Schlepper, W.-P. Klovekorn, W.-j. Cai, R. Zimmermann, K.-D. Muller, R. Strasser, S. Kostin, C. Gagel, B. Munkel, et al. Hibernating Myocardium : An Incomplete Adaptation to Ischemia Circulation, November 4, 1997; 96(9): 2920 - 2931. [Abstract] [Full Text]
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P. G. Camici, W. Wijns, M. Borgers, R. De Silva, R. Ferrari, J. Knuuti, A. A. Lammertsma, A. J. Liedtke, G. Paternostro, and S. F. Vatner Pathophysiological Mechanisms of Chronic Reversible Left Ventricular Dysfunction due to Coronary Artery Disease (Hibernating Myocardium) Circulation, November 4, 1997; 96(9): 3205 - 3214. [Full Text]
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D. Pontillo and A. Capezzuto Nitroglycerin Echocardiography and Dobutamine Angiology, October 1, 1997; 48(10): 931 - 932. [PDF]
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A. Cohen, C. Chauvel, B. Benhalima, P. Guyon, I. Desert, J. Valty, and A. Cohen Is Dobutamine Stress Echocardiography Useful for Noninvasive Differentiation of Ischemic from Idiopathic Dilated Cardiomyopathy? Angiology, September 1, 1997; 48(9): 783 - 793. [Abstract] [PDF]
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G. von Degenfeld, W. Giehrl, and P. Boekstegers Targeting of dobutamine to ischemic myocardium without systemic effects by selective suction and pressure-regulated retroinfusion Cardiovasc Res, August 1, 1997; 35(2): 233 - 240. [Abstract] [Full Text] [PDF]
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G. L. Murray, N. Schad, A. J. Bush, and G. L. Murray Viability After Myocardial Infarction: Can It Be Assessed Within Five Minutes by Low-Dose Dynamic Iodine-123-Iodophenylpentadecanoic Acid Imaging with a Multicrystal Gamma Camera? Angiology, April 1, 1997; 48(4): 309 - 319. [Abstract] [PDF]
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 G. Kleikamp, H. Posival, K. Minami, A. El-Banayosy, and R. Korfer Ischemic cardiomyopathy -- revascularization vs. transplantation Eur. J. Cardiothorac. Surg., April 1, 1997; 11(suppl): S1 - S4. [Abstract] [PDF]
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J.-L. J. Vanoverschelde, W. Wijns, M. Borgers, G. Heyndrickx, C. Depre, W. Flameng, and J. A. Melin Chronic Myocardial Hibernation in Humans: From Bedside to Bench Circulation, April 1, 1997; 95(7): 1961 - 1971. [Full Text]
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M. D. Cheitlin, J. S. Alpert, W. F. Armstrong, G. P. Aurigemma, G. A. Beller, F. Z. Bierman, T. W. Davidson, J. L. Davis, P. S. Douglas, L. D. Gillam, et al. ACC/AHA Guidelines for the Clinical Application of Echocardiography : A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Clinical Application of Echocardiography) Developed in Collaboration With the American Society of Echocardiography Circulation, March 18, 1997; 95(6): 1686 - 1744. [Full Text]
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U. Qureshi, S. F. Nagueh, I. Afridi, P. Vaduganathan, A. Blaustein, M. S. Verani, W. L. Winters, and W. A. Zoghbi Dobutamine Echocardiography and Quantitative Rest-Redistribution 201Tl Tomography in Myocardial Hibernation: Relation of Contractile Reserve to 201Tl Uptake and Comparative Prediction of Recovery of Function Circulation, February 4, 1997; 95(3): 626 - 635. [Abstract] [Full Text]
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S. H. Rahimtoola Hibernating Myocardium Has Reduced Blood Flow at Rest That Increases With Low-Dose Dobutamine Circulation, December 15, 1996; 94(12): 3055 - 3061. [Full Text]
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R. O. Bonow Identification of Viable Myocardium Circulation, December 1, 1996; 94(11): 2674 - 2680. [Full Text]
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A. I. McGhie and A. Weyman Searching for Hibernating Myocardium: Time to Reevaluate Investigative Strategies? Circulation, December 1, 1996; 94(11): 2685 - 2688. [Full Text]
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P. Perrone-Filardi, L. Pace, M. Prastaro, F. Squame, S. Betocchi, A. Soricelli, F. Piscione, C. Indolfi, T. Crisci, M. Salvatore, et al. Assessment of Myocardial Viability in Patients With Chronic Coronary Artery Disease: Rest–4-Hour–24-Hour 201Tl Tomography Versus Dobutamine Echocardiography Circulation, December 1, 1996; 94(11): 2712 - 2719. [Abstract] [Full Text]
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K. G. Kostopoulos, A. I. Kranidis, K. P. Bouki, J. P. Antonellis, K. G. Kappos, F. E. Rodogianni, N. J. Zamanis, A. G. Tavernarakis, C. T. Lolas, and L. P. Anthopoulos Detection of Myocardial Viability in the Prediction of Improvement in Left Ventricular Function After Successful Coronary Revascularization by Using the Dobutamine Stress Echocardiography and Quantitative SPECT Rest-Redistribution-Reinjection 201TI Imaging After Dipyridamole Infusion Angiology, November 1, 1996; 47(11): 1039 - 1046. [Abstract] [PDF]
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C. Chen, L. Chen, J. T. Fallon, L. Ma, L. Li, L. Bow, D. Knibbs, R. McKay, L. D. Gillam, and D. D. Waters Functional and Structural Alterations With 24-Hour Myocardial Hibernation and Recovery After Reperfusion: A Pig Model of Myocardial Hibernation Circulation, August 1, 1996; 94(3): 507 - 516. [Abstract] [Full Text]
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D. Pontillo, G. P. Carboni, A. Capezzuto, C. Alessi, A. Achilli, F. Piccini, and R. Guerra Identification of Viable Myocardium by Nitrate Echocardiography After Myocardial Infarction: Comparison with Planar Thallium Reinjection Scintigraphy Angiology, May 1, 1996; 47(5): 437 - 446. [Abstract] [PDF]
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S. Kaul There May Be More to Myocardial Viability Than Meets the Eye! Circulation, November 15, 1995; 92(10): 2790 - 2793. [Full Text]
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C. R. deFilippi, D. L. Willett, W. N. Irani, E. J. Eichhorn, C. E. Velasco, and P. A. Grayburn Comparison of Myocardial Contrast Echocardiography and Low-Dose Dobutamine Stress Echocardiography in Predicting Recovery of Left Ventricular Function After Coronary Revascularization in Chronic Ischemic Heart Disease Circulation, November 15, 1995; 92(10): 2863 - 2868. [Abstract] [Full Text]
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J.-L. J. Vanoverschelde, B. L. Gerber, A.-M. D'Hondt, M. De Kock, R. Dion, W. Wijns, and J. A. Melin Preoperative Selection of Patients With Severely Impaired Left Ventricular Function for Coronary Revascularization : Role of Low-Dose Dobutamine Echocardiography and Exercise-Redistribution-Reinjection Thallium SPECT Circulation, November 1, 1995; 92(9): 37 - 44. [Abstract] [Full Text]
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C. Chen, L. Li, L. L. Chen, J. V. Prada, M. H. Chen, J. T. Fallon, A. E. Weyman, D. Waters, and L. Gillam Incremental Doses of Dobutamine Induce a Biphasic Response in Dysfunctional Left Ventricular Regions Subtending Coronary Stenoses Circulation, August 15, 1995; 92(4): 756 - 766. [Abstract] [Full Text]
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V. Sansoy, D. K. Glover, D. D. Watson, M. Ruiz, W. H. Smith, J. P. Simanis, and G. A. Beller Comparison of Thallium-201 Resting Redistribution With Technetium-99m–Sestamibi Uptake and Functional Response to Dobutamine for Assessment of Myocardial Viability Circulation, August 15, 1995; 92(4): 994 - 1004. [Abstract] [Full Text]
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M. Arnese, J. H. Cornel, A. Salustri, A. P.W.M. Maat, A. Elhendy, A. E.M. Reijs, F. J. Ten Cate, D. Keane, A. H.M.M. Balk, J. R.T.C. Roelandt, et al. Prediction of Improvement of Regional Left Ventricular Function After Surgical Revascularization : A Comparison of Low-Dose Dobutamine Echocardiography With 201Tl Single-Photon Emission Computed Tomography Circulation, June 1, 1995; 91(11): 2748 - 2752. [Abstract] [Full Text]
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P. Perrone-Filardi, L. Pace, M. Prastaro, F. Piscione, S. Betocchi, F. Squame, P. Vezzuto, A. Soricelli, C. Indolfi, M. Salvatore, et al. Dobutamine Echocardiography Predicts Improvement of Hypoperfused Dysfunctional Myocardium After Revascularization in Patients With Coronary Artery Disease Circulation, May 15, 1995; 91(10): 2556 - 2565. [Abstract] [Full Text]
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J. A. Panza, V. Dilsizian, J. M. Laurienzo, R. V. Curiel, and P. T. Katsiyiannis Relation Between Thallium Uptake and Contractile Response to Dobutamine : Implications Regarding Myocardial Viability in Patients With Chronic Coronary Artery Disease and Left Ventricular Dysfunction Circulation, February 15, 1995; 91(4): 990 - 998. [Abstract] [Full Text]
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H. Ito, K. Iwakura, H. Oh, T. Masuyama, M. Hori, Y. Higashino, K. Fujii, and T. Minamino Temporal Changes in Myocardial Perfusion Patterns in Patients With Reperfused Anterior Wall Myocardial Infarction : Their Relation to Myocardial Viability Circulation, February 1, 1995; 91(3): 656 - 662. [Abstract] [Full Text]
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 E. C. Madu, W. Ahmar, J. Arthur, and T. D. Fraker Jr Clinical Utility of Digital Dobutamine Stress Echocardiography in the Noninvasive Evaluation of Coronary Artery Disease Arch Intern Med, May 23, 1994; 154(10): 1065 - 1072. [Abstract] [PDF]
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