Effects of Low-Dose Dobutamine on Displacement of the Atrioventricular Plane and Assessment of Myocardial Viability in Patients with Acute Myocardial Infarction Treated with Thrombolysis.

Abstract

Previous echocardiographic studies have highlighted the usefulness of atrioventricular (AV) plane displacement (the mitral annular motion) in assessing left ventricular function at rest. However, the effects of low-dose dobutamine on AV plane displacement in thrombolyzed patients with acute myocardial infarction (AMI) are unknown. Thirty-four patients with AMI treated with a thrombolytic agent and having rest wall motion abnormalities at the infarct site were studied with rest and low-dose dobutamine echocardiography before discharge. Thirty-one patients were followed up 18 months later with rest echocardiography. The systolic descent of the AV plane toward the apex at four different left ventricular sites (i.e., at the septal, anterior, lateral, and inferior walls) was recorded to assess left ventricular function. Compared with age-matched healthy subjects, the AV plane displacement was significantly reduced, especially at the infarct sites, in AMI patients at rest. During low-dose dobutamine, the AV plane displacement was increased at infarct sites (P < 0.001) in patients with signs of viability. A cutoff point of an increase in AV plane displacement of >/= 2 mm at the infarct sites during low-dose dobutamine stress had a sensitivity of 89% and a specificity of 87% in assessing myocardial viability. Using the same cutoff point of a spontaneous increase in the AV plane displacement of >/= 2 mm during the follow-up rest echocardiography, 87% of the patients with initial signs of viability and only 25% without signs of viability showed a spontaneous late recovery of initially stunned myocardium. Thus, the study shows that changes in the amplitude of the AV plane displacement during low-dose dobutamine stress echocardiography can easily be used to detect myocardial viability at an early stage with late potential spontaneous recovery.