小剂量多巴酚丁胺超声心动图可检测急性心肌梗死溶栓治疗后的可逆性功能障碍。

Low-dose dobutamine echocardiography detects reversible dysfunction after thrombolytic therapy of acute myocardial infarction.

作者信息

Smart S C, Sawada S, Ryan T, Segar D, Atherton L, Berkovitz K, Bourdillon P D, Feigenbaum H

机构信息

Krannert Institute of Cardiology, Department of Medicine, Indiana University School of Medicine, Indianapolis.

出版信息

Circulation. 1993 Aug;88(2):405-15. doi: 10.1161/01.cir.88.2.405.

DOI:10.1161/01.cir.88.2.405

PMID:8339404

Abstract

BACKGROUND

Dysfunction after thrombolytic therapy of acute myocardial infarction (MI) may be reversible. Early after myocardial infarction, both reversible and irreversible injury may be manifested by regional wall motion abnormalities. Improved wall thickening during dobutamine infusion (dobutamine-responsive wall motion) may accurately identify reversibly injured segments.

METHODS AND RESULTS

To determine whether dobutamine-responsive wall motion accurately detects reversible postischemic dysfunction irrespective of infarct location, multistage (baseline, 4 and 12 micrograms.kg-1.min-1, and peak) dobutamine echocardiography (DE) was performed within 7 days of thrombolytic therapy. Resting echocardiography was repeated > or = 4 weeks after MI, and reversible dysfunction was defined as improved wall motion. The accuracy of dobutamine-responsive wall motion was compared with that of signs of early reperfusion, non-Q-wave MI, and peak creatine kinase (CK). Sixty-three patients underwent DE without complications. Follow-up echocardiograms were done in 51 (81%) of these patients, and wall motion improved in 22 (41%). Dobutamine-responsive wall motion during all stages of DE was very specific for reversible dysfunction (90% to 93%) but sensitive (86%) only when hemodynamics were not altered (low dose, 4 micrograms.kg-1.min-1). Non-Q-wave MI and a low peak CK (< 1000 IU/mL) were also specific (89% to 93%) but less sensitive (64% [P = .16] and 55% [P < .05], respectively). Signs of early reperfusion did not identify postischemic dysfunction. Low-dose dobutamine-responsive wall motion and non-Q-wave MI independently identified reversible dysfunction, but only dobutamine-responsive wall motion was sensitive in all infarct locations. Non-Q-wave MI was sensitive only in anterior infarction.

CONCLUSIONS

Multistage dobutamine echocardiography can be performed safely early after thrombolytic therapy. Low-dose dobutamine-responsive wall motion accurately detected reversible dysfunction in all infarct locations. Dobutamine-responsive wall motion and non-Q-wave infarction may be very useful for accurately identifying reversible dysfunction early after thrombolytic therapy for acute MI.

摘要

背景

急性心肌梗死（MI）溶栓治疗后的功能障碍可能是可逆的。在心肌梗死后早期，可逆性和不可逆性损伤均可表现为局部室壁运动异常。多巴酚丁胺输注期间室壁增厚改善（多巴酚丁胺反应性室壁运动）可准确识别可逆性损伤节段。

方法与结果

为了确定多巴酚丁胺反应性室壁运动是否能准确检测出与梗死部位无关的缺血后可逆性功能障碍，在溶栓治疗7天内进行了多阶段（基线、4和12微克·千克⁻¹·分钟⁻¹以及峰值）多巴酚丁胺超声心动图（DE）检查。心肌梗死后≥4周重复静息超声心动图检查，可逆性功能障碍定义为室壁运动改善。将多巴酚丁胺反应性室壁运动的准确性与早期再灌注迹象、非Q波心肌梗死以及肌酸激酶（CK）峰值进行比较。63例患者接受了DE检查且无并发症。其中51例（81%）患者进行了随访超声心动图检查，22例（41%）患者的室壁运动得到改善。DE各阶段的多巴酚丁胺反应性室壁运动对可逆性功能障碍具有高度特异性（90%至93%），但仅在血流动力学未改变时（低剂量，4微克·千克⁻¹·分钟⁻¹）敏感（86%）。非Q波心肌梗死和低CK峰值（<1000 IU/mL）也具有特异性（89%至93%），但敏感性较低（分别为64%[P = 0.16]和55%[P < 0.05]）。早期再灌注迹象无法识别缺血后功能障碍。低剂量多巴酚丁胺反应性室壁运动和非Q波心肌梗死可独立识别可逆性功能障碍，但只有多巴酚丁胺反应性室壁运动在所有梗死部位均敏感。非Q波心肌梗死仅在前壁梗死中敏感。