POSTEXTRASYSTOLIC POTENTIATION ECHOCARDIOGRAPHY IN PREDICTING REVERSIBLE MYOCARDIAL DYSFUNCTION BY SURGICAL CORONARY REVASCULARIZATION

Sustained inotropic stimulation, such as dobutamine infusion, has the potential to cause an additional contractile deterioration in viable b ut chronically hypoperfused and dysfunctioning myocardium, by inducing ischemia. Postextrasystolic potentiation (PESP) represents a potent i notropic stimulus without risk of provoking ischemia, as it is instant aneous. In this study, we assessed the Pole of PESP-echocardiographic examination in predicting the recovery of regional contractility after coronary revascularization. We examined 105 consecutive patients with multivessel coronary artery disease who were candidates for bypass su rgery; 79 were included in this prospective study. Preoperative revers ibility of contractile dysfunction in asynergic myocardial regions was determined by PESP, with a coupling interval of 500 msec decreasing t o 300 msec, with a progressive decrease by 10 msec. The examination wa s accompanied by continuous 2-dimensional (2D) echocardiographic monit oring. The assessed sensitivity and specificity were 92% and 87%, resp ectively; the predictive accuracy was 90%. These results demonstrated that PESP echocardiography is a useful and cost-effective method for i dentifying viable myocardium in patients undergoing myocardial revascu larization. (C) 1998 by Excerpta Medica, Inc.