From the Division of Cardiology, Department of Medicine, Allegheny
University of the Health Sciences, Allegheny Campus, Pittsburgh, Pa.
Correspondence to Christopher M. Kramer, MD, Cardiology Division, Allegheny General Hospital, 320 E North Ave, Pittsburgh, PA 15212. E-mail ckramer{at}pgh.auhs.edu
Background—The assessment of return
of function within dysfunctional myocardium after acute
myocardial infarction (MI) using contractile reserve has been primarily
qualitative. Magnetic resonance (MR) myocardial tagging is a novel
noninvasive method that measures intramyocardial function. We
hypothesized that MR tagging could be used to quantify the
intramyocardial response to low-dose dobutamine and relate
this response to return of function in patients after first
MI.
Methods and Results—Twenty patients with a first reperfused MI
(age, 53±12 years; 16 male; 11 inferior MIs) were studied.
Patients underwent breath-hold MR-tagged short-axis imaging on day 4±2
after MI at baseline and during dobutamine infusion at 5
and 10 µg · kg-1 · min-1. At
8±1 weeks after MI, patients returned for a follow-up MR tagging study
without dobutamine. Quantification of percent
intramyocardial circumferential segment shortening (%S) was performed.
Low-dose dobutamine MRI was well tolerated. Overall, mean
%S was 15±11% at baseline (n=227 segments), increased to 16±10% at
5 µg · kg-1 · min-1
dobutamine (P=NS), 21±10% at peak
(P<0.0001 versus baseline and 5 µg ·
kg-1 · min-1), and 18±10% at 8 weeks
(P<0.004 versus baseline and peak). The increase in %S
with peak dobutamine was greater in dysfunctional
myocardium (103 segments, +9±10%) than in normal tissue
(124 segments, +4±12%, P<0.0001). In dysfunctional
regions, %S also increased from 6±7% at baseline to 14±10% at 8
weeks after MI (P<0.0001). In dysfunctional regions
that responded normally to peak dobutamine (
Conclusions—The response of intramyocardial function to low-dose
dobutamine after reperfused MI can be quantified with MR
tagging. Dysfunctional tissue after MI demonstrates a larger
contractile response to dobutamine than normal
myocardium. A normal increase in shortening elicited by
dobutamine within dysfunctional midwall and subepicardium
predicts greater functional recovery at 8 weeks after MI, but the
response within the subendocardium is not predictive.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Quantitative Assessment of Myocardial Viability After Infarction by Dobutamine Magnetic Resonance Tagging
5% increase
in %S), the increase in %S from baseline to 8 weeks after MI
(+9±9%) was greater than in those regions that did not respond
normally (+5±9%, P<0.04). Midmyocardial and
subepicardial response to dobutamine were predictive of
functional recovery, but the subendocardial response was not.
Key Words: magnetic resonance imaging • myocardial infarction • myocardial contraction • mechanics • stunning, myocardial
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