The use of dobutamine stress echocardiography for the determination of myocardial viability

Abstract

Summary:Determining the presence of viable myocardium has prognostic and therapeutic implications in the treatment of ischemic heart disease. Dobutamine stress echocardiography (DSE) is one possible technique to help identify both hibernating and stunned but viable myocardium. Low-dose dobutamine infusion has an increased inotropic effect, while higher doses cause both inotropic and chronotropic effects. Thus, at lower doses cardiac augmentation occurs, and at higher doses regions of ischemia may be produced in the presence of significant coronary artery disease. This is manifested echocardiographically as changes in segmental wall motion. In theory, therefore, areas of viable myocardium should show improved wall motion at low doses, and areas of irreversible myocardial damage will remain akinetic. Five studies have investigated DSE for determining viability in the setting of acute myocardial infarction, thus looking for stunned but viable myocardium. DSE was shown to compare favorably with positron emission tomography and was highly sensitive and specific for predicting functional myocardial recovery. Five additional studies examined DSE for determining the presence of hibernating myocardium. The sensitivity and specificity of DSE were found to range from 7 1 to 92% and from 73 to 93%, respectively. The benefits of DSE include lower cost, convenience to both patient and physician, additional ancillary information, and determination of Supported in part by the Herman C. Krannert Fund; grants HL-06308 and HL-07 182 from the National Heart, Lung. and Blood Institute, National Institutes of Health, Bethesda. Maryland; and the American Heart Association, Indiana Affiliate, Indianapolis, Indiana

Quantitative Assessment of Myocardial Viability After Infarction by Dobutamine Magnetic Resonance Tagging

“…[3][4][5] Limitations of such methods include the subjective qualitative assessment and resultant variability in the interpretation of the images. 6,7 Other limitations include the effects of throughplane motion, 8 which results in imaging different myocardial regions at end diastole and end systole. In addition, echocardiography cannot examine the transmural variation in mechanical function.…”

“…6,7 In addition, to avoid errors in interpretation, factors such as tethering and through-plane motion must be considered, because different regions of myocardium are evaluated from end-diastolic and end-systolic images. 8 In theory, DSE can detect only a large volume of viable myocardium, 8 because it requires that enough myocardium be involved to translate viability into a visible increase in wall motion. Assessment of the transmural heterogeneity of response is not possible by echocardiography.…”

Could 13C MRI assist clinical decision‐making for patients with heart disease?

“…Because of the clinical implications, multiple methods have been investigated to assess directly or indirectly the metabolic state of the left ventricle. Dobutamine stress echocardiography, exercise echocardiography, positron tomography, SPECT and late enhancement after gadolinium by MRI have all been proposed for the detection of viable myocardium . The large literature can be summarized as follows: it is widely accepted that the correct identification of viable myocardium influences patient care, yet there is no universally accepted method to achieve this goal.…”

Caracterización del infarto de miocardio por RM.Cuantificación de parámetros morfológicos y funcionales.

“…En estos casos se utiliza la ecocardiografía de estrés para evaluar si existen alteraciones de la contractilidad segmentaria esto se debe a que al inducir un estrés por medio de ejercicio o la perfusión de fármacos, que producen una sobrecarga del corazón, esto permite comparar la movilidad segmentaria durante una situación basal y una situación con estrés y valorar si hay o no anomalías durante la contractilidad del VI. En la evaluación de la viabilidad miocárdica se induce un estrés con dosis bajas de dobutamina, ya que tras un infarto con necrosis transmural, la inducción de estrés con dobutamina produce una mejoría de la contractilidad segmentaria en los segmentos viables [9,[20][21][22].…”

“…La mejoría de la función sistólica con dobutamina se ha usado ampliamente para predecir la recuperación de la función sistólica tras un IAMEST, fundamentalmente con la ecocardiografía de estrés [20,21].…”