INFARCT-RELATED CORONARY ARTERY ANGIOPLASTY: Relation between residual stenosis, contractile reserve, and functional recovery

Abstract

I . In patients with impaired left ventricular function due to \myocardial infarction; the distinction betw en irreversibly damaged scar tissue land viable myocardium has important clinical implications concerning risk stratification and I outcome of revascularization. Dobutamine stress echocardiography I has been I established as a valuable technique for the evaluation of myocardial iability by I

detection of contractile reserve and! or ischemia. \

The aim of this study was to investigate the accuracy of dobutamie induced I wall motion abnormalities in the infarct zone for detection of residual stenosis in the I infarct-related artery, and to study the effects of infarct-related artery I revascularization on the contractility of the infarcted-myocardium, as wdll as, wall . I motion abnormalities outside the infarct-zone in multivessel coronary arteri disease. I I

The study included 30 patients with history•of acute myocardial

infarction 1 I

more .than thre.e weeks who had residual resting regional wall motion abnolnnalities. Methods include: Clinical assessment, 12 lead electrocardiogram (ECG}, routine i laboratory tests, echocardiographic study to determine left ventricular! ejection I fraction (LVEF), patterns of regional wall motion abnormalities and wall motion I score index (WMSI) both in the infarct-zones as well as outside the infatct zones. 1

Intravenous dobutamine infusion at 3-minutes incremental dosage stages starting at I

a dose of 5 uglkg/min was given to every patient. Intravenous 1mg atrobine was

I given to 16 patients who did not reach target heart rate.