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European Heart Journal 2000 21(6):446-456; doi:10.1053/euhj.1999.1732
Copyright © 2000 by the European Society of Cardiology.
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Dispersion of ventricular repolarization is determined by the presence of myocardial viability in patients with old myocardial infarction. A dobutamine stress echocardiography study

I Ikonomidis, G Athanassopoulos, G Karatasakis, A.S Manolis, M Marinou, A Economou and D.V Cokkinosf1

1st Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece

revised May 28, 1999; accepted June 2, 1999

Abstract

Aims The study sought to investigate the relationship of myocardial viability detected by dobutamine stress echocardiography to changes of QT dispersion and to the presence of arrhythmias during dobutamine infusion in patients with old myocardial infarction. We also examined whether patency of the infarct-related artery is associated with the presence of myocardial viability and QT dispersion.

Background QT dispersion and myocardial variability have been associated with the presence of arrhythmias during late post infarction but not during dobutamine stress. Restoration of anterograde coronary flow has beneficial effects on ventricular systolic function and repolarization, suggesting that the extent of viable myocardium may determine ventricular repolarization.

Methods Seventy five patients with previous myocardial infarction were studied in a low dose (up to 20µg–1.kg–1. min–1) dobutamine stress echocardiography study. ECGs were obtained at rest and peak stress for measurement of QT intervals. The presence of ventricular arrhythmias (Lown grade >lb) during stress was noted. A reduction in the total wall motion score of the left ventricle at peak stress confirmed the presence of myocardial viability.

Results Dobutamine infusion increased QT dispersion in all patients (P<0·01). Patients with myocardial viability had a lower resting QT dispersion (P<0·05) and a greater increase in QT dispersion% (P<0·01) than patients without. The combination of a resting QT dispersion <65ms or an increase in QT dispersion >30% predicted viability with a sensitivity of 67%, a specificity of 96%, and an accuracy of 78%. A patent infarct-related artery, as well as ventricular arrhythmias, were more commonly observed in patients with evidence of viable myocardium (P<0·05). Patients with arrhythmias had a higher QT dispersion than patients without (P<0·05).

Conclusion The combination of a resting QT dispersion ±65ms or an increase in QT dispersion >30% predicts the presence of viable myocardium and thus, may represent a simple index for the assessment of viability in everyday clinical practice. Myocardial viability is related to a patent coronary artery and to a high incidence of arrhythmias accompanied by a greater increase in QT dispersion at peak dobutamine infusion.

Key Words: Myocardial viability, QT dispersion, dobutamine stress echocardiography, arrhythmias

f1 Correspondence: Prof. Dennis V. Cokkinos, 1st Department of Cardiology, Onassis Cardiac Surgery Center, Syngrou Avenue 356, 17674, Athens, Greece.


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