Dobutamine -Induced ST-Segment Elevation in Patients With Acute Myocardial Infarction and the Role of Myocardial Ischemia, Viability, and Ventricular Dyssynergy

Ricci, Roberto; Bigi, Riccardo; Galati, Alfonso; Bandini, P.; Coletta, Claudio; Fiorentini, Cesare; Lumia, Francesca; Occhi, Giuseppe; Ceci, Vincenzo

doi:10.1016/s0002-9149(96)00859-4

Cited by 33 publications

(23 citation statements)

References 26 publications

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“…It has been shown that myocardial ischemia is accompanied by stress-induced ST-segment elevation, because reversible defects have been found on exercise thallium scintigraphy, 1,6 and the degree of stress-induced ST-segment elevation decreases after coronary revascularization. 2,15 On the other hand, some have concluded that such ST-segment elevations are not related to myocardial ischemia, [16][17][18] based on the finding that the prevalence of myocardial ischemia does not differ in patients with or without dobutamineinduced ST-segment elevation. In addition, the degree of exercise-induced ST-segment elevation is attenuated after MI without revascularization.…”

Section: Discussionmentioning

confidence: 99%

Stress-Induced ST-Segment Elevation Following Myocardial Infarction and Its Role in Wall Motion Abnormality, Myocardial Ischemia and Viability. Comparison of Response to Exercise, Dobutamine and Dipyridamole.

et al. 2001

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tress-induced ST-segment elevation is a common finding in patients after myocardial infarction (MI), but its mechanism is still controversial. It has been interpreted as a sign of myocardial ischemia, 1,2 left ventricular wall motion abnormality (WMA) 3,4 or both, 5,6 and recent studies have suggested that ST-segment elevation during stress reflects myocardial viability. [7][8][9][10][11] Stress echocardiography has been proposed as a useful technique for the assessment of myocardial ischemia, left ventricular dysfunction and myocardial viability, but although exercise and pharmacological stress, such as dobutamine and dipyridamole, are widely used in stress echocardiography, there has not been a comparative study of the significance of the stressinduced ST-segment elevation of exercise, dobutamine and dipyridamole in identical patients. Dobutamine and dipyridamole differ in their mechanism of inducing myocardial ischemia: dobutamine is a -receptor agonist that increases myocardial oxygen consumption, whereas dipyridamole causes vasodilation and induces vertical and horizontal blood steals. 12 The purpose of the present study was to determine the relationship between ST-segment elevation Japanese Circulation Journal Vol. 65, December 2001 and wall motion response during exercise, dobutamine and dipyridamole stresses, and to examine the mechanism of stress-induced ST-segment elevation following MI. MethodsTwenty-five consecutive patients, 24 men and 1 woman, aged 53±10 years, were prospectively enrolled. The criteria for recruitment were (1) admission to hospital with a diagnosis of first anterior acute MI and (2) abnormal Q wave in at least 2 leads on the electrocardiogram (ECG) performed in conjunction with stress echocardiography. Patients with bundle branch block (n=2), left ventricular hypertrophy (n=2), unstable angina (n=1), left ventricular failure (n=1), bronchial asthma (n=1), and those unable to exercise adequately (n=3) were excluded. One patient developed serious ventricular arrhythmia during a low dose dobutamine test (10 g·kg -1 ·min -1 ) was also excluded. Sixteen patients were treated with thrombolytic agents within 24 h from the beginning of symptoms and 5 patients underwent coronary angioplasty within 48 h from the onset of MI. None of the patients had a coronary stent implanted. Each patient underwent, in random order, exercise, dobutamine and dipyridamole echocardiography on different days and under the same medication. All stress tests were performed 4-6 weeks after the onset of MI. All antianginal drugs, such as -adrenergic blocking agents, nitrates and calcium antagonists, were discontinued on the day before the stress Stress-induced ST-segment elevation following myocardial infarction (MI) has been correlated with myocardial ischemia, viability and wall motion abnormality, but its mechanism is still unclear, so the present study compared ST-segment elevation and wall motion response during exercise, dobutamine and dipyridamole stresses. Twentyfive patients with their first anterior MI ...

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Section: Discussionmentioning

confidence: 99%

Stress-Induced ST-Segment Elevation Following Myocardial Infarction and Its Role in Wall Motion Abnormality, Myocardial Ischemia and Viability. Comparison of Response to Exercise, Dobutamine and Dipyridamole.

et al. 2001

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“…Studies of the relationship among stress-induced ST segment elevation, myocardial viability and ischaemia after myocardial infarction have gained increasing interest, particularly in the thrombolytic era, as a large proportion of patients retain viable myocardium which may improve spontaneously or after revascularization [1][2][3][4] . It is important to identify viable myocardium in order to match patients to the most appropriate strategy for improvement of left ventricular function.…”

Section: See Page 814 For the Article To Which This Editorial Refersmentioning

confidence: 99%

“…Many studies have concluded that stress-induced ST segment elevation is not a specific sign of regional myocardial ischaemia after myocardial infarction as opposed to patients without previous infarction [1,3,6] . Most of these studies demonstrated a similar prevalence of ischaemia in patients with and without ST segment elevation.…”

Section: Relationship Between St Segment Elevation and Myocardial Iscmentioning

confidence: 99%

The unresolved mystery of stress-induced ST segment elevation after myocardial infarcation

Elhendy

Khandheria

Seward

2000

European Heart Journal

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“…Paradoxically, the information gleaned from these imaging methods has not clarified the interpretation of this ECG phenomenon, but has instead generated more confusion. Some investigators conclude that EISTE in Q wave leads is a highly specific marker of residual myocardial viability [1, 2, 3, 4, 5, 6, 7, 8], while others report strong evidence to the contrary [9, 10, 11, 12, 13, 14, 15](table 1). Such apparently discordant and mutually exclusive data are difficult to explain solely on the basis of differences in patient populations or methods.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, no unified hypotheses explain the mechanisms that underlie EISTE in Q wave leads. This ECG phenomenon has been attributed by various researchers to (a) wall motion abnormality [9, 10, 11, 16, 17, 18, 19, 20, 21], (b) myocardial ischemia [9, 10, 11, 12, 22, 23, 24], (c) both (a) and (b) [25, 26, 27, 28, 29], or (d) neither (a) nor (b) [30, 31, 32]. The failure of these explanations to encompass the full scope of the electrocardiographic and electrophysiologic mechanisms that underlie EISTE in Q wave leads inspired our critical review of this ECG phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Exercise-Induced ST Segment Elevation in Q Wave Leads in Postinfarction Patients: Defining Its Meaning and Utility in Today’s Practice

Gussak

Wright²,

Kopecky

et al. 2000

Cardiology

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Most attempts to identify qualitative and quantitative techniques for assessing myocardial viability and the likelihood of improved function after revascularization in patients with healed myocardial infarcts have focused on treatment strategies and prognosis. This review examines the true value of the electrocardiographic phenomenon of exercise-induced ST segment elevation (EISTE) in Q wave leads as a diagnostic tool for the assessment of myocardial viability. The prognostic potential and clinical utility of the EISTE phenomenon are inhibited both by the heart’s electrophysiologic response to exercise-induced metabolic and hemodynamic changes, and by the ECG’s limited facility in assessing myocardial preservation. The use of EISTE as an independent indicator for surgical intervention is proscribed by these limitations. The EISTE phenomenon could serve as a useful tool in the first line of discrimination in patients with healed Q wave myocardial infarction, and may justify further diagnostic work-up in patients under consideration for a revascularization procedure. In the era of sophisticated nuclear and echo techniques, accurate imaging studies should not be replaced by ECG analysis alone in the search for viable tissue, except when financial costs are of major importance.

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Dobutamine -Induced ST-Segment Elevation in Patients With Acute Myocardial Infarction and the Role of Myocardial Ischemia, Viability, and Ventricular Dyssynergy

Cited by 33 publications

References 26 publications

Stress-Induced ST-Segment Elevation Following Myocardial Infarction and Its Role in Wall Motion Abnormality, Myocardial Ischemia and Viability. Comparison of Response to Exercise, Dobutamine and Dipyridamole.

Stress-Induced ST-Segment Elevation Following Myocardial Infarction and Its Role in Wall Motion Abnormality, Myocardial Ischemia and Viability. Comparison of Response to Exercise, Dobutamine and Dipyridamole.

The unresolved mystery of stress-induced ST segment elevation after myocardial infarcation

Exercise-Induced ST Segment Elevation in Q Wave Leads in Postinfarction Patients: Defining Its Meaning and Utility in Today’s Practice

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