Significance of dobutamine-induced changes in QT dispersion early after acute myocardial infarction

Abstract

This study sought to examine the effects of graded dobutamine infusion on QT dispersion early after acute myocardial infarction (AMI) and to investigate the relation of dobutamine-induced changes in QT dispersion to wall motion responses. Seventy-eight patients with a first AMI underwent dobutamine-atropine stress echocardiography 5 ± 2 days after admission. Contractile reserve was identified in 45 patients and ischemic myocardium in 40. Sixteen patients had persistent akinesia. The best cut-off value of QT dispersion on the baseline electrocardiogram for predicting myocardial viability was 65 ms (sensitivity and specificity of 68%). Dobutamine infusion increased QT dispersion only in patients with viable myocardium (61 ± 18 to 83 ± 19 ms, p = 0.003) and/or ischemia (72 ± 16 to 112 ± 25 ms, p <0.0001). No change was observed in patients with persistent akinesia (84 ± 10 to 87 ± 15 ms, p = NS). QT dispersion increased by 22 ± 12 ms with administration of low-dose dobutamine in patients who had viable myocardium and by 47 ± 21 ms with administration of low- to high-dose dobutamine in patients with ischemic myocardium. An increase in QT dispersion of ≥20 ms from at rest to low-dose dobutamine infusion was associated with myocardial viability with a sensitivity of 78% and a specificity of 79%, whereas an increase in QT dispersion of ≥10 ms from low- to high-dose dobutamine infusion predicted ischemic myocardium with a sensitivity of 85% and a specificity of 82%. In conclusion, (1) low QT dispersion on the baseline electrocardiogram is determined by the presence of viable myocardium, (2) a dobutamine-induced increase in QT dispersion is associated with viable and jeopardized myocardium, and (3) unchanged QT dispersion during dobutamine stress is a simple marker of extensive necrosis.