Watada H, Ito H, Oh H, Masuyama T, Aburaya M, Hori M, Iwakura M, Higashino Y, Fujii K, Minamino T
Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan.
J Am Coll Cardiol. 1994 Sep;24(3):624-30. doi: 10.1016/0735-1097(94)90006-x.
This study was designed to evaluate dobutamine stress echocardiography in identifying reversible dysfunction and assessing the extent of irreversibly damaged myocardium early in acute myocardial infarction.
Several experimental and clinical studies have suggested that dobutamine enhances contractile function of stunned or hibernating, or both, myocardium. It is important for clinical strategy to predict the magnitude of improvement in myocardial function early in acute myocardial infarction.
We studied 21 patients with a reperfused first anterior myocardial infarction. Two-dimensional echocardiography was performed before and during dobutamine infusion (10 micrograms/kg body weight per min) at a mean of 3 days after the infarction. Follow-up echocardiography was performed at a mean of 25 days later. To assess segmental wall motion, we divided the left ventricle into 17 segments and assigned a wall motion abnormality score: 3 = dyskinesia or akinesia; 0 = normal. Improvement in wall motion was indicated by a decrease of at least one grade in segmental score. For quantitative assessment, the ratio of endocardial length showing dyskinesia or akinesia to a left ventricular endocardial length (akinetic length ratio) was determined in the apical long-axis view at each stage.
Sensitivity and specificity of dobutamine infusion in detecting improvement in wall motion at follow-up echocardiography were 83% (55 of 66 segments) and 86% (43 of 50 segments), respectively. Excellent correlation was found (r = 0.93, p < 0.001; absolute difference [mean +/- SD] 0.03 +/- 0.05) between the akinetic length ratios measured during dobutamine infusion and in the late convalescent stage.
In the early stage of acute myocardial infarction, low dose dobutamine stress echocardiography provides a useful method for predicting reversible dysfunction with excellent sensitivity and specificity and can also be used to quantitate the extent of irreversibly damaged myocardium.
本研究旨在评估多巴酚丁胺负荷超声心动图在急性心肌梗死早期识别可逆性功能障碍及评估不可逆损伤心肌范围方面的作用。
多项实验和临床研究表明，多巴酚丁胺可增强顿抑或冬眠心肌或两者的收缩功能。在急性心肌梗死早期预测心肌功能改善程度对临床策略很重要。
我们研究了21例首次发生前壁心肌梗死且已再灌注的患者。在心肌梗死后平均3天，于多巴酚丁胺输注（每分钟10微克/千克体重）前及输注期间进行二维超声心动图检查。平均25天后进行随访超声心动图检查。为评估节段性室壁运动，我们将左心室分为17个节段，并赋予室壁运动异常评分：3 = 运动障碍或运动不能；0 = 正常。节段评分至少降低一级表明室壁运动改善。为进行定量评估，在每个阶段的心尖长轴视图中测定显示运动障碍或运动不能的心内膜长度与左心室心内膜长度之比（运动不能长度比）。
多巴酚丁胺输注在随访超声心动图中检测室壁运动改善的敏感性和特异性分别为83%（66个节段中的55个）和86%（50个节段中的43个）。多巴酚丁胺输注期间和恢复期后期测得的运动不能长度比之间存在极好的相关性（r = 0.93，p < 0.001；绝对差值[均值±标准差]为0.03±0.05）。
在急性心肌梗死早期，低剂量多巴酚丁胺负荷超声心动图为预测可逆性功能障碍提供了一种有用的方法，具有出色的敏感性和特异性，还可用于定量评估不可逆损伤心肌的范围。
