Low-dose dobutamine echocardiography detects reversible dysfunction after thrombolytic therapy of acute myocardial infarction

Steven C. Smart, Stephen Sawada, Thomas Ryan, Douglas Segar, Lawrence Atherton, Kenneth Berkovitz, Patrick D V Bourdillon, Harvey Feigenbaum

Research output: Contribution to journalArticle

352 Citations (Scopus)

Abstract

Background. Dysfunction after thrombolytic therapy of acute myocardial infarction (MI) may be reversible. Early after myocardial infarction, both reversible and irreversible injury may be manifested by regional wall motion abnormalities. Improved wall thickening during dobutamine infusion (dobutamine-responsive wall motion) may accurately identify reversibly injured segments. Methods and Results. To determine whether dobutamine-responsive wall motion accurately detects reversible postischemic dysfunction irrespective of infarct location, multistage (baseline, 4 and 12 μg · kg-1 · min-1, and peak) dobutamine echocardiography (DE) was performed within 7 days of thrombolytic therapy. Resting echocardiography was repeated ≥4 weeks after MI, and reversible dysfunction was defined as improved wall motion. The accuracy of dobutamine-responsive wall motion was compared with that of signs of early reperfusion, non-Q-wave MI, and peak creatine kinase (CK). Sixty-three patients underwent DE without complications. Follow-up echocardiograms were done in 51 (81%) of these patients, and wall motion improved in 22 (41%). Dobutamine-responsive wall motion during all stages of DE was very specific for reversible dysfunction (90% to 93%) but sensitive (86%) only when hemodynamics were not altered (low dose, 4 μg · kg-1 · min-1). Non-Q-wave MI and a low peak CK (<1000 IU/mL) were also specific (89% to 93%) but less sensitive (64% [P=.16] and 55% [P<.05], respectively). Signs of early reperfusion did not identify postischemic dysfunction. Low-dose dobutamine-responsive wall motion and non-Q-wave MI independently identified reversible dysfunction, but only dobutamine-responsive wall motion was sensitive in all infarct locations. Non-Q-wave MI was sensitive only in anterior infarction. Conclusions. Multistage dobutamine echocardiography can be performed safely early after thrombolytic therapy. Low-dose dobutamine-responsive wall motion accurately detected reversible dysfunction in all infarct locations. Dobutamine-responsive wall motion and non-Q-wave infarction may be very useful for accurately identifying reversible dysfunction early after thrombolytic therapy for acute MI.

Original languageEnglish
Pages (from-to)405-415
Number of pages11
JournalCirculation
Volume88
Issue number2
StatePublished - Aug 1993

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Dobutamine
Thrombolytic Therapy
Echocardiography
Myocardial Infarction
Creatine Kinase
Infarction
Reperfusion

Keywords

  • Inotropic agents
  • Myocardial contraction
  • Myocardium
  • Reperfusion

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Low-dose dobutamine echocardiography detects reversible dysfunction after thrombolytic therapy of acute myocardial infarction. / Smart, Steven C.; Sawada, Stephen; Ryan, Thomas; Segar, Douglas; Atherton, Lawrence; Berkovitz, Kenneth; Bourdillon, Patrick D V; Feigenbaum, Harvey.

In: Circulation, Vol. 88, No. 2, 08.1993, p. 405-415.

Research output: Contribution to journalArticle

Smart, SC, Sawada, S, Ryan, T, Segar, D, Atherton, L, Berkovitz, K, Bourdillon, PDV & Feigenbaum, H 1993, 'Low-dose dobutamine echocardiography detects reversible dysfunction after thrombolytic therapy of acute myocardial infarction', Circulation, vol. 88, no. 2, pp. 405-415.
Smart, Steven C. ; Sawada, Stephen ; Ryan, Thomas ; Segar, Douglas ; Atherton, Lawrence ; Berkovitz, Kenneth ; Bourdillon, Patrick D V ; Feigenbaum, Harvey. / Low-dose dobutamine echocardiography detects reversible dysfunction after thrombolytic therapy of acute myocardial infarction. In: Circulation. 1993 ; Vol. 88, No. 2. pp. 405-415.
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abstract = "Background. Dysfunction after thrombolytic therapy of acute myocardial infarction (MI) may be reversible. Early after myocardial infarction, both reversible and irreversible injury may be manifested by regional wall motion abnormalities. Improved wall thickening during dobutamine infusion (dobutamine-responsive wall motion) may accurately identify reversibly injured segments. Methods and Results. To determine whether dobutamine-responsive wall motion accurately detects reversible postischemic dysfunction irrespective of infarct location, multistage (baseline, 4 and 12 μg · kg-1 · min-1, and peak) dobutamine echocardiography (DE) was performed within 7 days of thrombolytic therapy. Resting echocardiography was repeated ≥4 weeks after MI, and reversible dysfunction was defined as improved wall motion. The accuracy of dobutamine-responsive wall motion was compared with that of signs of early reperfusion, non-Q-wave MI, and peak creatine kinase (CK). Sixty-three patients underwent DE without complications. Follow-up echocardiograms were done in 51 (81{\%}) of these patients, and wall motion improved in 22 (41{\%}). Dobutamine-responsive wall motion during all stages of DE was very specific for reversible dysfunction (90{\%} to 93{\%}) but sensitive (86{\%}) only when hemodynamics were not altered (low dose, 4 μg · kg-1 · min-1). Non-Q-wave MI and a low peak CK (<1000 IU/mL) were also specific (89{\%} to 93{\%}) but less sensitive (64{\%} [P=.16] and 55{\%} [P<.05], respectively). Signs of early reperfusion did not identify postischemic dysfunction. Low-dose dobutamine-responsive wall motion and non-Q-wave MI independently identified reversible dysfunction, but only dobutamine-responsive wall motion was sensitive in all infarct locations. Non-Q-wave MI was sensitive only in anterior infarction. Conclusions. Multistage dobutamine echocardiography can be performed safely early after thrombolytic therapy. Low-dose dobutamine-responsive wall motion accurately detected reversible dysfunction in all infarct locations. Dobutamine-responsive wall motion and non-Q-wave infarction may be very useful for accurately identifying reversible dysfunction early after thrombolytic therapy for acute MI.",
keywords = "Inotropic agents, Myocardial contraction, Myocardium, Reperfusion",
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T1 - Low-dose dobutamine echocardiography detects reversible dysfunction after thrombolytic therapy of acute myocardial infarction

AU - Smart, Steven C.

AU - Sawada, Stephen

AU - Ryan, Thomas

AU - Segar, Douglas

AU - Atherton, Lawrence

AU - Berkovitz, Kenneth

AU - Bourdillon, Patrick D V

AU - Feigenbaum, Harvey

PY - 1993/8

Y1 - 1993/8

N2 - Background. Dysfunction after thrombolytic therapy of acute myocardial infarction (MI) may be reversible. Early after myocardial infarction, both reversible and irreversible injury may be manifested by regional wall motion abnormalities. Improved wall thickening during dobutamine infusion (dobutamine-responsive wall motion) may accurately identify reversibly injured segments. Methods and Results. To determine whether dobutamine-responsive wall motion accurately detects reversible postischemic dysfunction irrespective of infarct location, multistage (baseline, 4 and 12 μg · kg-1 · min-1, and peak) dobutamine echocardiography (DE) was performed within 7 days of thrombolytic therapy. Resting echocardiography was repeated ≥4 weeks after MI, and reversible dysfunction was defined as improved wall motion. The accuracy of dobutamine-responsive wall motion was compared with that of signs of early reperfusion, non-Q-wave MI, and peak creatine kinase (CK). Sixty-three patients underwent DE without complications. Follow-up echocardiograms were done in 51 (81%) of these patients, and wall motion improved in 22 (41%). Dobutamine-responsive wall motion during all stages of DE was very specific for reversible dysfunction (90% to 93%) but sensitive (86%) only when hemodynamics were not altered (low dose, 4 μg · kg-1 · min-1). Non-Q-wave MI and a low peak CK (<1000 IU/mL) were also specific (89% to 93%) but less sensitive (64% [P=.16] and 55% [P<.05], respectively). Signs of early reperfusion did not identify postischemic dysfunction. Low-dose dobutamine-responsive wall motion and non-Q-wave MI independently identified reversible dysfunction, but only dobutamine-responsive wall motion was sensitive in all infarct locations. Non-Q-wave MI was sensitive only in anterior infarction. Conclusions. Multistage dobutamine echocardiography can be performed safely early after thrombolytic therapy. Low-dose dobutamine-responsive wall motion accurately detected reversible dysfunction in all infarct locations. Dobutamine-responsive wall motion and non-Q-wave infarction may be very useful for accurately identifying reversible dysfunction early after thrombolytic therapy for acute MI.

AB - Background. Dysfunction after thrombolytic therapy of acute myocardial infarction (MI) may be reversible. Early after myocardial infarction, both reversible and irreversible injury may be manifested by regional wall motion abnormalities. Improved wall thickening during dobutamine infusion (dobutamine-responsive wall motion) may accurately identify reversibly injured segments. Methods and Results. To determine whether dobutamine-responsive wall motion accurately detects reversible postischemic dysfunction irrespective of infarct location, multistage (baseline, 4 and 12 μg · kg-1 · min-1, and peak) dobutamine echocardiography (DE) was performed within 7 days of thrombolytic therapy. Resting echocardiography was repeated ≥4 weeks after MI, and reversible dysfunction was defined as improved wall motion. The accuracy of dobutamine-responsive wall motion was compared with that of signs of early reperfusion, non-Q-wave MI, and peak creatine kinase (CK). Sixty-three patients underwent DE without complications. Follow-up echocardiograms were done in 51 (81%) of these patients, and wall motion improved in 22 (41%). Dobutamine-responsive wall motion during all stages of DE was very specific for reversible dysfunction (90% to 93%) but sensitive (86%) only when hemodynamics were not altered (low dose, 4 μg · kg-1 · min-1). Non-Q-wave MI and a low peak CK (<1000 IU/mL) were also specific (89% to 93%) but less sensitive (64% [P=.16] and 55% [P<.05], respectively). Signs of early reperfusion did not identify postischemic dysfunction. Low-dose dobutamine-responsive wall motion and non-Q-wave MI independently identified reversible dysfunction, but only dobutamine-responsive wall motion was sensitive in all infarct locations. Non-Q-wave MI was sensitive only in anterior infarction. Conclusions. Multistage dobutamine echocardiography can be performed safely early after thrombolytic therapy. Low-dose dobutamine-responsive wall motion accurately detected reversible dysfunction in all infarct locations. Dobutamine-responsive wall motion and non-Q-wave infarction may be very useful for accurately identifying reversible dysfunction early after thrombolytic therapy for acute MI.

KW - Inotropic agents

KW - Myocardial contraction

KW - Myocardium

KW - Reperfusion

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