Clinical and angiographic correlates of dobutamine-induced wall motion patterns after myocardial infarction

The ability of different dobutamine-induced wall motion patterns to define the anatomic status of the infarct-related artery (IRA) was evaluated in 15 9 patients who underwent dobutamine stress echocardiography, (DSE) and coro nary angiography 10 +/- 2 and 18 +/- 3 days, respectively, after hospital a dmission. The DSE result was classified as: (1) biphasic: improvement with a low dose followed by deterioration with a high dose; (2) worsening: direc t deterioration at low or high doses; (3) sustained improvement: improvemen t with a low dose that was maintained at high dose; and (4) no change: no c hange during the entire protocol. A diameter narrowing >70% (50% for the le ft main stem) of major Coronary arteries indicated a severe lesion. Angiogr ams were classified according to the jeopardy score and collateral circulat ion graded according to Rentrop's classification. DSE was positive in 92 pa tients (22 had biphasic results and 70 had worsening results) and negative in 67 patients (14 had sustained improvement and 53 had no changes). Biphas ic response was associated with more frequent anterior infarction (p <0.05) and higher resting (p <0.001) and peak (p <0.01) wall motion score indexes . The IRA was totally occluded in 4 of the 92 patients (4%) with positive ( worsening pattern) and 12 of the 67 patients (18%) with negative (no change pattern) tests. The biphasic pattern was associated with the highest jeopa rdy score and was significantly (p <0.05) more specific (100%) compared wit h worsening (78%) in identifying a severe stenosis of the IRA. The combinat ion of ischemic patterns provided a significantly superior sensitivity (p < 0.0001). Logistic regression analysis identified the biphasic pattern as th e only significant predictor. Conversely, the prediction of total occlusion of the IRA was poor. Sustained improvement was the most specific (100%) pr edictor of absence of severe stenosis of the IRA, whereas the combination w ith no change pattern provided a significantly superior sensitivity (p <0.0 001). Thus, DSE effectively predicts the residual stenosis of the IRA. In p articular, the biphasic response has an excellent specificity and positive predictive value and is the only significant predictor among clinical and e chocardiographic variables. (C)2001 by Excerpta Medica, Inc.