(Circulation. 1997;95:1394-1401.)
© 1997 American Heart Association, Inc.
Articles |
Safety and Accuracy of Dobutamine-Atropine Stress Echocardiography for the Detection of Residual Stenosis of the Infarct-Related Artery and Multivessel Disease During the First Week After Acute Myocardial Infarction
From the Division of Cardiology, Medical College of Wisconsin (Milwaukee).
Correspondence to Steven C. Smart, MD, Medical College of Wisconsin, Division of Cardiology, 8700 W Wisconsin Ave, Box 123, Milwaukee, WI 53226. E-mail ssmart{at}post.its.mcw.edu.
Background The safety of dobutamine-atropine echocardiography early after acute myocardial infarction is unknown. Its accuracy for the early detection of infarct artery stenosis and multivessel coronary artery disease is also unclear. The objective of the present study was to document its safety and accuracy during the first week after acute myocardial infarction.
Methods and Results Multistage dobutamine-atropine stress
echocardiography was performed in 232 patients (age, 58±13 years; 58
women) at 5±2 days after acute myocardial infarction. The peak heart
rate was 116±20 bpm. There were no episodes of sustained ventricular
tachycardia, myocardial infarction, or death. Atropine with dobutamine
was tolerated well. Coronary angiography was performed in 206 patients
(89%). There were 171 patients (83%) with infarct artery stenosis of
50% and 114 patients (55%) with multivessel disease. Ischemic or
biphasic responses in the infarction zone were 82% (140 of 171)
sensitive and 80% (28 of 35) specific for residual stenosis.
Sensitivity was similar for occluded arteries (77%, 36 of 47) and
patent but stenotic arteries (84%, 104 of 124). Wall motion
abnormalities outside the infarction zone were specific (97%, 89 of
92) and moderately sensitive (68%, 77 of 114) for multivessel disease.
The only determinant of sensitivity for residual infarct artery
stenosis was improved wall motion at low dose (P<.01). The
determinants of sensitivity for multivessel disease were peak heart
rate and infarct size (P<.01).
Conclusions Dobutamine-atropine stress echocardiography was safely used to detect residual infarct artery stenosis and multivessel disease during the first week after acute myocardial infarction. The test may be very effective for evaluating patients with acute myocardial infarction because sensitivity for residual stenosis and multivessel disease was maximal in the high-risk subsets of patients with viable, jeopardized myocardium and large infarct size.
Key Words: echocardiography • ischemia • myocardial infarction • stunning, myocardial
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