Evaluation of patterns of perfusion and metabolism in dobutamine-responsive myocardium

Stephen Sawada, G. Elsner, D. S. Segar, M. O'Shaughnessy, S. Khouri, J. Foltz, P. D V Bourdillon, J. R. Bates, N. Fineberg, T. Ryan, Gary Hutchins, Harvey Feigenbaum

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Abstract

Objectives. We investigated the patterns of perfusion and metabolism in dysfunctional myocardium whose contractility improved with dobutamine. Background. Clinical studies have suggested that dobutamine echocardiography can identify hibernating myocardium, but laboratory studies suggest that reduced perfusion limits the response to dobutamine. Methods. Twenty-five patients with coronary disease and ventricular dysfunction underwent low (5 and 10 μg/kg body weight per min) and high dose (maximum of 50 μg/kg per min) dobutamine echocardiography and positron emission tomography (PET) using nitrogen-13 (N-13) ammonia and fluorine-18 fluorodeoxyglucose (FDG) for imaging of perfusion and metabolism. Wall motion and tracer uptake were scored in 16 left ventricular segments. Results. Perfusion and metabolism were normal in 56.4%, mildly reduced in 29.1% and mismatched (reduced perfusion, preserved FDG uptake) in 14.5% of dysfunctional segments viable on PET. Wall motion improved with dobutamine in 89 dysfunctional segments (62 at low dose, 27 only at peak dose), and 86 of these (97%) were viable on PET. Improvement in wall motion with dobutamine was more common in segments with normal perfusion and metabolism (56.5%) than in those with mildly reduced tracer uptake (28.5%, p < 0.001) and those with mismatch (32%, p = 0.03). All the segments with a biphasic response were supplied by vessels with ≤70% stenosis, and 88% had normal perfusion and metabolism. Conclusions. The majority of viable segments with rest dysfunction had normal perfusion and metabolism, suggesting that myocardial stunning was common. Improvement of wall motion at low and high doses of dobutamine was highly correlated with myocardial viability on PET and was more common in myocardium with normal perfusion. A biphasic response to dobutamine identified segments with normal perfusion and metabolism supplied severely diseased vessels.

Original languageEnglish
Pages (from-to)55-61
Number of pages7
JournalJournal of the American College of Cardiology
Volume29
Issue number1
DOIs
StatePublished - 1997

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Dobutamine
Myocardium
Perfusion
Positron-Emission Tomography
Echocardiography
Myocardial Stunning
Ventricular Dysfunction
Perfusion Imaging
Fluorodeoxyglucose F18
Ammonia
Coronary Disease
Pathologic Constriction
Nitrogen
Body Weight

ASJC Scopus subject areas

  • Nursing(all)

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Evaluation of patterns of perfusion and metabolism in dobutamine-responsive myocardium. / Sawada, Stephen; Elsner, G.; Segar, D. S.; O'Shaughnessy, M.; Khouri, S.; Foltz, J.; Bourdillon, P. D V; Bates, J. R.; Fineberg, N.; Ryan, T.; Hutchins, Gary; Feigenbaum, Harvey.

In: Journal of the American College of Cardiology, Vol. 29, No. 1, 1997, p. 55-61.

Research output: Contribution to journalArticle

Sawada, S, Elsner, G, Segar, DS, O'Shaughnessy, M, Khouri, S, Foltz, J, Bourdillon, PDV, Bates, JR, Fineberg, N, Ryan, T, Hutchins, G & Feigenbaum, H 1997, 'Evaluation of patterns of perfusion and metabolism in dobutamine-responsive myocardium', Journal of the American College of Cardiology, vol. 29, no. 1, pp. 55-61. https://doi.org/10.1016/S0735-1097(96)00430-5
Sawada, Stephen ; Elsner, G. ; Segar, D. S. ; O'Shaughnessy, M. ; Khouri, S. ; Foltz, J. ; Bourdillon, P. D V ; Bates, J. R. ; Fineberg, N. ; Ryan, T. ; Hutchins, Gary ; Feigenbaum, Harvey. / Evaluation of patterns of perfusion and metabolism in dobutamine-responsive myocardium. In: Journal of the American College of Cardiology. 1997 ; Vol. 29, No. 1. pp. 55-61.
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abstract = "Objectives. We investigated the patterns of perfusion and metabolism in dysfunctional myocardium whose contractility improved with dobutamine. Background. Clinical studies have suggested that dobutamine echocardiography can identify hibernating myocardium, but laboratory studies suggest that reduced perfusion limits the response to dobutamine. Methods. Twenty-five patients with coronary disease and ventricular dysfunction underwent low (5 and 10 μg/kg body weight per min) and high dose (maximum of 50 μg/kg per min) dobutamine echocardiography and positron emission tomography (PET) using nitrogen-13 (N-13) ammonia and fluorine-18 fluorodeoxyglucose (FDG) for imaging of perfusion and metabolism. Wall motion and tracer uptake were scored in 16 left ventricular segments. Results. Perfusion and metabolism were normal in 56.4{\%}, mildly reduced in 29.1{\%} and mismatched (reduced perfusion, preserved FDG uptake) in 14.5{\%} of dysfunctional segments viable on PET. Wall motion improved with dobutamine in 89 dysfunctional segments (62 at low dose, 27 only at peak dose), and 86 of these (97{\%}) were viable on PET. Improvement in wall motion with dobutamine was more common in segments with normal perfusion and metabolism (56.5{\%}) than in those with mildly reduced tracer uptake (28.5{\%}, p < 0.001) and those with mismatch (32{\%}, p = 0.03). All the segments with a biphasic response were supplied by vessels with ≤70{\%} stenosis, and 88{\%} had normal perfusion and metabolism. Conclusions. The majority of viable segments with rest dysfunction had normal perfusion and metabolism, suggesting that myocardial stunning was common. Improvement of wall motion at low and high doses of dobutamine was highly correlated with myocardial viability on PET and was more common in myocardium with normal perfusion. A biphasic response to dobutamine identified segments with normal perfusion and metabolism supplied severely diseased vessels.",
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T1 - Evaluation of patterns of perfusion and metabolism in dobutamine-responsive myocardium

AU - Sawada, Stephen

AU - Elsner, G.

AU - Segar, D. S.

AU - O'Shaughnessy, M.

AU - Khouri, S.

AU - Foltz, J.

AU - Bourdillon, P. D V

AU - Bates, J. R.

AU - Fineberg, N.

AU - Ryan, T.

AU - Hutchins, Gary

AU - Feigenbaum, Harvey

PY - 1997

Y1 - 1997

N2 - Objectives. We investigated the patterns of perfusion and metabolism in dysfunctional myocardium whose contractility improved with dobutamine. Background. Clinical studies have suggested that dobutamine echocardiography can identify hibernating myocardium, but laboratory studies suggest that reduced perfusion limits the response to dobutamine. Methods. Twenty-five patients with coronary disease and ventricular dysfunction underwent low (5 and 10 μg/kg body weight per min) and high dose (maximum of 50 μg/kg per min) dobutamine echocardiography and positron emission tomography (PET) using nitrogen-13 (N-13) ammonia and fluorine-18 fluorodeoxyglucose (FDG) for imaging of perfusion and metabolism. Wall motion and tracer uptake were scored in 16 left ventricular segments. Results. Perfusion and metabolism were normal in 56.4%, mildly reduced in 29.1% and mismatched (reduced perfusion, preserved FDG uptake) in 14.5% of dysfunctional segments viable on PET. Wall motion improved with dobutamine in 89 dysfunctional segments (62 at low dose, 27 only at peak dose), and 86 of these (97%) were viable on PET. Improvement in wall motion with dobutamine was more common in segments with normal perfusion and metabolism (56.5%) than in those with mildly reduced tracer uptake (28.5%, p < 0.001) and those with mismatch (32%, p = 0.03). All the segments with a biphasic response were supplied by vessels with ≤70% stenosis, and 88% had normal perfusion and metabolism. Conclusions. The majority of viable segments with rest dysfunction had normal perfusion and metabolism, suggesting that myocardial stunning was common. Improvement of wall motion at low and high doses of dobutamine was highly correlated with myocardial viability on PET and was more common in myocardium with normal perfusion. A biphasic response to dobutamine identified segments with normal perfusion and metabolism supplied severely diseased vessels.

AB - Objectives. We investigated the patterns of perfusion and metabolism in dysfunctional myocardium whose contractility improved with dobutamine. Background. Clinical studies have suggested that dobutamine echocardiography can identify hibernating myocardium, but laboratory studies suggest that reduced perfusion limits the response to dobutamine. Methods. Twenty-five patients with coronary disease and ventricular dysfunction underwent low (5 and 10 μg/kg body weight per min) and high dose (maximum of 50 μg/kg per min) dobutamine echocardiography and positron emission tomography (PET) using nitrogen-13 (N-13) ammonia and fluorine-18 fluorodeoxyglucose (FDG) for imaging of perfusion and metabolism. Wall motion and tracer uptake were scored in 16 left ventricular segments. Results. Perfusion and metabolism were normal in 56.4%, mildly reduced in 29.1% and mismatched (reduced perfusion, preserved FDG uptake) in 14.5% of dysfunctional segments viable on PET. Wall motion improved with dobutamine in 89 dysfunctional segments (62 at low dose, 27 only at peak dose), and 86 of these (97%) were viable on PET. Improvement in wall motion with dobutamine was more common in segments with normal perfusion and metabolism (56.5%) than in those with mildly reduced tracer uptake (28.5%, p < 0.001) and those with mismatch (32%, p = 0.03). All the segments with a biphasic response were supplied by vessels with ≤70% stenosis, and 88% had normal perfusion and metabolism. Conclusions. The majority of viable segments with rest dysfunction had normal perfusion and metabolism, suggesting that myocardial stunning was common. Improvement of wall motion at low and high doses of dobutamine was highly correlated with myocardial viability on PET and was more common in myocardium with normal perfusion. A biphasic response to dobutamine identified segments with normal perfusion and metabolism supplied severely diseased vessels.

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