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European Heart Journal 2000 21(10):814-822; doi:10.1053/euhj.1999.1942
Copyright © 2000 by the European Society of Cardiology.
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Dobutamine- vs exercise-induced ST segment elevation early after Q wave myocardial infarction. Prediction of functional recovery after revascularization

N.E. Mezilis, F.I. Parthenakis, M.K. Kanakaraki, M.E. Marketou, H.E. Mavrakis and P.E. Vardas

Cardiology Department, University Hospital of Heraklion, Crete, Greece

revised September 13, 1999; accepted September 15, 1999

Abstract

Aims The association between stress-induced ST elevation and functional recovery following revascularization after myocardial infarction remains unclear. We assessed the relative accuracy of dobutamine- and exercise-induced ST elevation in Q wave leads in predicting functional recovery following revascularization, and we investigated the relationship of ST elevation to different wall motion responses to dobutamine.

Methods and Results Thirty-nine patients underwent dobutamine stress echo and exercise test 8±2 days after Q wave myocardial infarction. All patients underwent angiography and subsequent revascularization. Follow-up echocardiograms were obtained 7±4 weeks after revascularization. Functional recovery was assessed by the difference between the baseline and the follow-up asynergy index. Nineteen patients (48%) developed dobutamine- and exercise-induced ST elevation. There was significant agreement between the tests (k=0·58, P<0·001). We found a significant correlation between dobutamine and exercise-induced ST elevation with functional recovery following revascularization (r=0·45,P <0·005 and r=0·7, P<0·001, respectively). The parameters with the highest predictive value for functional recovery were: (a) the biphasic response during dobutamine infusion, (b) the development of ST elevation in both tests, and (c) the development of exercise-induced ST elevation in more than three leads.

Conclusion There is a strong association between dobutamine- and exercise-induced ST elevation with functional recovery following revascularization. Exercise-induced ST elevation in more than three leads and a biphasic response during dobutamine infusion accurately predict functional recovery.

Key Words: Acute myocardial infarction, dobutamine stress echo, exercise treadmill test, ST segment elevation

Correspondence: Prof. P. E. Vardas, MD, PhD (London), FESC, FACC, Cardiology Department, Heraklion University Hospital, P.O. Box 1352 Stavrakia, Heraklion, Crete, Greece.

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