DOBUTAMINE STRESS ECHOCARDIOCRAPHY PREDICTS EARLY WALL MOTION IMPROVEMENT AFTER ELECTIVE PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Abstract

PTCA is now widely accepted as a non surgical revascularization procedure for selected patients with coronary artery disease.

DSE is sensitive and specific both in ischemia and hibernation detection and has been used safely after PTCA .

Aiming to prove the role of DSE in identification of hibernating myocardium before elective PTCA and for early demonstration of the expected ischemia relief and hibernation recovery after PTCA , 30 patients (25 males and 5 females ), who had previous coronary angiograms showing significant coronary stenoses in at least one of the major coronary vessels and candidate for PTCA in Embaba National Heart Institute. We excluded those with previous PTCA , by pas surgery and recent myocardial infarction (within one month before the admission) or unstable angina . DSE was done within 2 days before PTCA. Dobutamine was given at a rates of 5,10, 20, 30 and 40 I kg/min. in three minutes stages . Careful history and examination were undertaken with ECG and blood pressure monitoring pre- , intra- and post test. Segmental wall motion in 16 segments model, recommended by American Society of Echocardiography were assessed by stress apparatus, evaluating all degree of dyssenergy ( hypo-, a- and dys-kinasia) and yielding wall motion score index at resting , low dose and high dose stages. The end points were mainly maximal dose 40 kg/min. completed, typical chest pain, severe arrhythmia, extreme hyper - or hypotension and expected maximal heart rate reached. Patients were classified into three groups: hibernating (9 patients)(lf a resting regional wall motion abnormality was improved)• , ischemic (10 patients )( If worsened regional wall motion abnormality was induced by high dose ) and mixed (8 patients ) according to wall motion score index at rest , low dose and high dose stages , while the test is non conclusive in three of patients. PTCA were performed and complete revascularization was done to all epicardial vessels. Second DSE was done within 2 days after PTCA.