Enoximone echocardiography for predicting recovery of left ventricular dysfunction after revascularization - A novel test for detecting myocardial viability

Background-The possibility that enoximone, a nonglycoside, noncatechol, pos itive inotropic agent, in combination with 2-dimensional echocardiography m ay predict recovery of myocardial dysfunction after revascularization has n ot been yet evaluated. Methods and Results-Forty-five patients with chronic coronary artery diseas e and left ventricular dysfunction underwent dobutamine (DE, 5 to 10 mu g . kg(-1) . min(-1)) and enoximone (EE, 1.5 mg/kg, over 10 minutes) echocardi ography. Myocardial wall motion was scored from 1 (normal) to 4 (dyskinesia ): an asynergic segment was considered to have contractile enhancement when the score decreased by greater than or equal to 1 grade. Of 478 asynergic segments, 216 (45%) exhibited functional recovery after revascularization. Dobutamine- and enoximone-induced contractile enhancement was observed in 4 1% and 46% of segments, respectively, Compared with DE, EE had higher sensi tivity (88% versus 79%, P<0.01) and negative predictive value (90% versus 8 4%, P<0.05) in predicting functional recovery. The specificity (89% versus 90%) and positive predictive value (87% for both EE and DE) were similar. C oncordant interpretation of EE and DE findings was found in 85% (406 of 478 ) of affected segments. Prerevascularization coronary angiography showed th at stenosis severity of vessels supplying areas which only improved with en oximone was significantly greater (89.9%) than that of vessels (77.7%) supp lying areas that responded to both agents (P<0.02), Both dobutamine and eno ximone increased heart rate (16% and 10%, respectively), whereas enoximone did not cause changes in systolic blood pressure that increased by 14% with dobutamine. Conclusions-Enoximone echocardiography provides a novel and reliable approa ch for the prediction of functional recovery after revascularization. Compa red with dobutamine echocardiography, the test yields higher sensitivity an d induces lesser hemodynamic alterations.