COMBINED USE OF DOBUTAMINE ECHOCARDIOGRAPHY AND MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY IN PREDICTING REGIONAL DYSFUNCTION RECOVERY AFTER CORONARY REVASCULARIZATION IN PATIENTS WITH RECENT MYOCARDIAL-INFARCTION

Background Myocardial contrast echocardiography and dobutamine echocar diography have recently emerged as potentially useful clinical tools t o detect reversible myocardial dysfunction. However, the relative accu racy of these two techniques in predicting regional wall motion improv ement after coronary interventions is still unclear. The aim of the pr esent study was to compare their diagnostic value in predicting functi onal recovery after coronary revascularization in patients with recent acute myocardial infarction. Methods and results Twenty-four patients with acute myocardial infarction underwent myocardial contrast echoca rdiography and dobutamine echocardiography within 2 weeks of hospital admission. Infarct zone contrast score and wall motion score indexes w ere derived in each patient. Infarct-related artery revascularization was performed before hospital discharge in all selected patients. Rest ing echocardiography was repeated 3 months after revascularization, an d regional function recovery was analysed. The degree of wall motion s core improvement at 3-month follow-up and the percentage of positive r esponses to dobutamine echo were greater (P<0.001 and P<0.002, respect ively) in patients with a higher baseline contrast score (greater than or equal to 0.50). Conversely, no significant changes were observed e ither during dobutamine echo or after revascularization in the group o f patients without residual perfusion within the infarct area. Diagnos tic agreement between both techniques in predicting reversible dysfunc tion was high (81% of segments). The sensitivity and negative predicti ve value in predicting functional outcome were 100% (95% confidence in terval [CI], 87% to 100%) and 100% (95% CI, 93% to 100%) by contrast e cho, and 85% (95% CI, 66% to 96%) and 93% (95% CI, 84% to 98%) by dobu tamine echo. The specificity and positive predictive Value were 90% (9 5% CI, 80% to 96%) and 81% (95% CI, 64% to 93%) by contrast echo, and 88% (95% CI, 78% to 95%) and 76% (95% CI, 58% to 90%) by dobutamine ec ho. The combination of myocardial contrast and dobutamine echocardiogr aphy positive responses improved specificity and positive predictive v alue in detecting functional recovery after revascularization to 100% (95% CI, 94% to 100%) and 100% (95% CI, 85% to 100%), respectively. Ho w ever, the sensitivity and negative predictive value slightly decreas ed with the use of both methods (85% [95% CI, 66% to 96%)] and (93% [9 5% CI, 85% to 98%)], respectively. Conclusions In patients with recent myocardial infarction, reversible dysfunction after coronary revascul arization and the response to dobutamine infusion are strictly depende nt on microvascular integrity. However, microvascular perfusion does n ot always imply functional recovery after coronary revascularization. The integration with dobutamine echo results seems particularly helpfu l to further improve myocardial contrast echo specificity and positive predictive values.