Relation between ST segment elevation during dobutamine stress test and myocardial viability after a recent myocardial infarction.

Abstract

The accuracy of ST segment elevation for the prediction of functional improvement was similar to that of low dose dobutamine echocardiography in patients with anterior infarction (80% v 83%) and in patients who underwent revascularisation (78% v 83% respectively). Conclusion-In patients with a recent Q wave myocardial infarction, dobutamineinduced ST segment elevation is a valuable marker of myocardial viability particularly when the test is performed without or with suboptimal echocardiographic imaging.

Incidence, Pathophysiology, and Treatment of Complications During Dobutamine-Atropine Stress Echocardiography

“…[92][93][94][95][96][97] Le diagnostic de spasme coronaire ne peut être définitivement porté qu'après réalisation d'une coronarographie avec épreuve de provocation par l'ergonovine, l'acétylcholine ou la dobutamine.…”

“…ST-segment elevation in noninfarct leads has also been linked to transmural myocardial ischemia due to severe CAD. [92][93][94][95][96][97] The final diagnosis of coronary spasm can only be confirmed on coronary angiography with ergonovine, acetylcholine, or dobutamine provocation. 85,87 Treatment Sublingual nitroglycerin should be administered first rather than ␤-blocking agents 83,84 because of a small risk of exacerbation of spasm with a ␤-blocker.…”

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

“…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.…”

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.

“…26 It has been shown that the effect of -adrenergic stimulation on action potential is more prominent in non-infarcted myocardium than in the infarcted territory 27,28 and this generates a difference in the resting and action potentials between the 2 areas, resulting in a current of injury, which would be recorded as ST-segment elevation on ECG. 29 The ST-segment elevation is a valuable marker for myocardial viability, 10 as well as a predictive sign of improvement of myocardial function following acute MI and revascularization. [7][8][9] Positron emission tomography studies have shown that a majority of recently infarcted myocardial regions retain residual metabolic activity in patients showing ST-segment elevation.…”

“…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.…”