Low-dose dobutamine echocardiography and rest-redistribution thallium-201 tomography in the assessment of spontaneous recovery of left ventricular function after recent myocardial infarction

Elhendy, Abdou; Trocino, Giuseppe; Salustri, Alessandro; Cornel, Jan H.; Roelandt, Jos R.T.C.; Boersma, Eric; Domburg, Ron T. van; Krenning, Eric P.; El-Said, Galal M.; Fioretti, P.

doi:10.1016/s0002-8703(96)90082-4

Cited by 33 publications

(14 citation statements)

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“…26) Moreover, it has been reported that LDSE (5 and 10µg/kg/min only) 5 to 14 days after acute myocardial infarction was as sensitive but more specific than rest-redistribution thallium-201 scan for reversible dysfunction by echocardiography 3 months later. 8,27) Dobutamine stress echocardiography is more accurate, especially in akinetic segments, and is minimally influenced by clinical factors. 8) The only clinical factor that reduced accuracy is a nonanterior infarction location.…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Terminal QRS Complex Distortion and Early Low Dose Dobutamine Stress Echocardiography in Acute Anterior Myocardial Infarction

et al. 2004

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SUMMARYAlthough the damage in myocardial infarction has been demonstrated to be related with the magnitude and number of ST elevation, its relation with terminal distortion of QRS is unclear. The relationship between terminal QRS distortion in ECGs on admission and the results of early low dose dobutamine stress echocardiography (LDSE) performed 6 ± 2 days later was investigated.Patients admitted to our clinic within the first six hours of their chest pain and without a prior infarction diagnosis were divided into two groups based on the admission electrocardiogram as the absence (QRS-, n = 33) or presence (QRS+, n = 29) of distortion of the terminal portion of the QRS in ≥ 2 leads (QRS+; J point at > 50% of the R wave amplitude in lateral leads or presence of ST elevation without S wave in leads V 1 -V 3 ).There were no significant differences between the groups with respect to thrombolytic therapy or reperfusion criteria. During LDSE, the infarct zone wall motion score index (WMSI) in the QRS-group was significantly decreased relative to baseline (from 2.93 ± 0.65 to 2.37 ± 0.84, P = 0.02), and it was significantly different compared with WMSI in the QRS+ group (P = 0.005). Improvement of akinetic regions to hypokinetic regions in the infarct zone (IZ) was found to be 33.5% (44/131) in the QRS-group and 17.8% (27/ 151 P = 0.004) in the QRS+ group. Furthermore, 55.1% (10/29) of the patients in the QRS+ group and only 18.1% (6/33) of those in the QRS-group did not respond to LDSE (P < 0.05). In multiple logistic regression analysis, while there was no relationship between good left ventricular functions (WMSI < 2) and terminal QRS distortion under basal conditions (P = 0.07), an independent relation was observed to exist between them after LDSE (P = 0.03, OR 4.48, 95% CI, 1.13-17.7). Moreover, plasma CK levels were higher in the QRS+ group (P = 0.03), whereas the ejection fraction was worse (P = 0.01). In both groups, there was no correlation between the Selvester score and left ventricle WMSI at baseline, but this correlation was significantly improved with LDSE (QRS-; r = 0.39 P = 0.02 and QRS+; r = 0.44 P = 0.01)From the

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Section: Discussionmentioning

confidence: 99%

The Relationship Between Terminal QRS Complex Distortion and Early Low Dose Dobutamine Stress Echocardiography in Acute Anterior Myocardial Infarction

et al. 2004

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“…Precise, quantitative measurements of myocardial function (strain) may allow clinicians to detect ischemia during stress testing with lower doses of inotropic agents. Also, the detection of functional recovery in stunned myocardium during low dose dobutamine infusion may be used to detect viable myocardium (10)(11)(12)(13)(14); this requires a technique that is very sensitive to small changes in myocardial strain. In this paper, we present a method for reconstructing a three-dimensional strain field of the left ventricle (LV) from a collection of tagged MR images.…”

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confidence: 99%

Model‐free reconstruction of three‐dimensional myocardial strain from planar tagged MR images

Denney

McVeigh

1997

Magnetic Resonance Imaging

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A technique is presented for reconstructing a three-dimensional myocardial strain map from a set of parallel-tagged MR images. Radial strains were reconstructed from in vivo data from an anesthetized dog with values between .05 and .1 with a precision of ± .003 for a tag detection accuracy of .1 mm and a tag spacing of 2.5 mm. The reconstruction spatial resolution was demonstrated by reconstructing a localized displacement abnormality. In the circumferential direction, the abnormality that resulted in 5O% displacement attenuation had a full width at half maximum of 5.4 ± .4 mm (mean ± SD). Graphs are presented showing the relationship between the size of an abnormality and the ability of the method to reconstruct that abnormality. The combination of high resolution parallel-tagged MR images and the model-free, coordinate system-free strain reconstruction technique presented in this paper is capable of producing accurate, high resolution strain maps of the myocardium. KeywordsCardiac MRI; Left ventricle; Cardiac mechanics; Spatial resolution Recent developments in MR tagging (1-9) make it possible to noninvasively measure the threedimensional motion of the heart wall. In tagged images, the myocardium appears with a spatially encoded pattern that moves with the tissue and can be analyzed to reconstruct the motion of the myocardium and measures of local contractile performance such as strain. Precise, quantitative measurements of myocardial function (strain) may allow clinicians to detect ischemia during stress testing with lower doses of inotropic agents. Also, the detection of functional recovery in stunned myocardium during low dose dobutamine infusion may be used to detect viable myocardium (10)(11)(12)(13)(14); this requires a technique that is very sensitive to small changes in myocardial strain. In this paper, we present a method for reconstructing a three-dimensional strain field of the left ventricle (LV) from a collection of tagged MR images.O'Dell et al (8) presented a three-dimensional strain reconstruction algorithm based on a prolate spheroidal basis function displacement model. This approach produces excellent results at the midwall, but careful preprocessing is required to get the heart in the correct coordinate system for reconstruction because the coordinate system foci and axes are critical to the reconstruction accuracy. Young et al (7,15) and Moulton et al (16) have developed three-dimensional strain reconstruction schemes based on a 16-element mesh and a piece-wise polynomial displacementCorrespondence to: Thomas S. Denney, Jr.. In this paper, we present a new model-free algorithm for reconstructing three-dimensional strain based on the discrete approach of Denney and Prince (9). The discrete model-free (DMF) algorithm decomposes the myocardial volume into a finely spaced mesh of points and reconstructs a high resolution three-dimensional displacement field using finite difference analysis and a smoothness constraint that minimizes the spatial variation of displacement across the myoc...

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“…The relative merit of these parameters was demonstrated to detect myocardial viability before successful revascularization, 13,22) but the optimal diagnostic approaches using these parameters simultaneously for identifying myocardial stunning after reperfusion and for predicting the final functional recovery have not been clarified in the clinical setting. In the present study, the usefulness of simultaneous evaluation of contractile reserve, perfusion, and free fatty acid metabolism at dobutamine stress testing for diagnosing myocardial stunning was clarified.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of Simultaneous Evaluations of Contractile Reserve, Perfusion, and Metabolism During Dobutamine Stress for Predicting Wall Motion Reversibility (Myocardial Stunning) After Successful PTCA

et al. 2004

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SUMMARYThe optimal diagnostic approaches using contractile reserve, perfusion, and free fatty acid metabolism together for identifying myocardial stunning after reperfusion have not been clarified in the clinical setting. We investigated the usefulness of simultaneous evaluation of these parameters during myocardial stunning to predict the functional recovery in infarct-related myocardium after reperfusion.In 43 patients (60.7 ± 10.4 years) with successful coronary angioplasty early after a first myocardial infarction, low-dose (5 to 10 µg/kg/min) dobutamine stress thallium-201/ iodine-123 β-methyl-iodophenyl pentadecanoic acid (BMIPP) dual-isotope single photon emission computed tomography was performed with echocardiography in the acute phase within 1 week after reperfusion. Regional wall motion and the uptake of each tracer were obtained simultaneously in the infarct-related segments.In 93 segments with dyssynergy in the acute phase after reperfusion, the sensitivity, specificity, and accuracy using contractile reserve for predicting the final functional recovery in the chronic phase more than 3 months after PTCA were 81.3%, 67.2%, and 72%, respectively. More accurate predictions were obtained by simultaneous measurements of thallium-201 and BMIPP uptakes (93.8%, 66.7%, and 79.4%, respectively).The final functional recovery in the stunned myocardium after early reperfusion following acute myocardial infarction was predicted more accurately by simultaneous evaluation of these parameters at dobutamine stress testing. (Jpn Heart J 2004; 45: 195-204) Key words: Myocardial stunning, Myocardial infarction, PTCA, EARLY reperfusion of an acutely occluded coronary artery results in the recovery of left ventricular function and life saving, however, the effectiveness of reFrom the

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Low-dose dobutamine echocardiography and rest-redistribution thallium-201 tomography in the assessment of spontaneous recovery of left ventricular function after recent myocardial infarction

Cited by 33 publications

References 26 publications

The Relationship Between Terminal QRS Complex Distortion and Early Low Dose Dobutamine Stress Echocardiography in Acute Anterior Myocardial Infarction

The Relationship Between Terminal QRS Complex Distortion and Early Low Dose Dobutamine Stress Echocardiography in Acute Anterior Myocardial Infarction

Model‐free reconstruction of three‐dimensional myocardial strain from planar tagged MR images

Usefulness of Simultaneous Evaluations of Contractile Reserve, Perfusion, and Metabolism During Dobutamine Stress for Predicting Wall Motion Reversibility (Myocardial Stunning) After Successful PTCA

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