Low-dose dobutamine in patients with acute myocardial infarction identifies viable but not contractile myocardium and predicts the magnitude of improvement in wall motion abnormalities in response to coronary revascularization

Francesco Barilla, Mihai Gheorghiade*, Mohsin Alam, Fareed Khaja, Sidney Goldstein

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

206 Scopus citations

Abstract

To assess the effects of coronary revascularization on viable but noncontractile myocardium, we examined 21 patients with a documented anterior acute myocardial infarction who had a significant improvement in wall motion abnormality evaluated by two-dimensional echocardiography in the infarct-related artery in response to low-dose dobutamine infusion. All patients had a significant residual stenosis in the infarct-related artery. In response to low-dose dobutamine, there was a marked improvement in contractility in the infarct-related area segments and this was reflected by a decrease in echocardiographic score index from 1.5 ± 0.15 to 1.09 ± 0.08 (p = 0.0001). Of these 21 patients, 13 underwent successful revascularization: 10 had percutaneous transluminal coronary angioplasty (PTCA) and three had coronary artery bypass grafts (CABG) (group I). Eight patients received medical therapy only (group II). At 40 ± 15 days of follow-up, both groups had improvement in their segmental wall motion abnormalities. However, the improvement in group I was greater than that in group II, 1.1 ± 0.13 and 1.35 ± 0.1, respectively (p = 0.0002). We conclude that: (1) low-dose dobutamine infusion may identify viable but noncontractile myocardium in patients with acute myocardial infarction and (2) in these patients revascularization causes a greater improvement in left ventricular function over time when compared with a nonrevascularized group.

Original languageEnglish (US)
Pages (from-to)1522-1531
Number of pages10
JournalAmerican heart journal
Volume122
Issue number6
DOIs
StatePublished - Dec 1991

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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