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Low-dose adenosine stress echocardiography: detection of myocardial viability.

Djordjevic-Dikic A, Ostojic M, Beleslin B, Nedeljkovic I, Stepanovic J, Stojkovic S, Petrasinovic Z, Nedeljkovic M, Saponjski J, Giga V - Cardiovasc Ultrasound (2003)

Bottom Line: Wall motion score index improved from rest 1.55 +/- 0.30 to 1.33 +/- 0.26 at low-dose adenosine (p < 0.001).Follow-up wall motion score index was 1.31 +/- 0.30 (p < 0.001 vs. rest).Positive and negative predictive values were 97% and 80%, respectively.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute for Cardiovascular Diseases, Dept. for Diagnostic and Catheterization Laboratories, Clinical Center of Serbia, 8 Koste Todorovica, 11000 Belgrade, Yugoslavia. skali@bitsyu.net

ABSTRACT

Objective: The aim of this study was to evaluate the diagnostic potential of low-dose adenosine stress echocardiography in detection of myocardial viability.

Background: Vasodilation through low dose dipyridamole infusion may recruit contractile reserve by increasing coronary flow or by increasing levels of endogenous adenosine.

Methods: Forty-three patients with resting dyssynergy, due to previous myocardial infarction, underwent low-dose adenosine (80, 100, 110 mcg/kg/min in 3 minutes intervals) echocardiography test. Gold standard for myocardial viability was improvement in systolic thickening of dyssinergic segments of >or= 1 grade at follow-up. Coronary angiography was done in 41 pts. Twenty-seven patients were revascularized and 16 were medically treated. Echocardiographic follow up data (12 +/- 2 months) were available in 24 revascularized patients.

Results: Wall motion score index improved from rest 1.55 +/- 0.30 to 1.33 +/- 0.26 at low-dose adenosine (p < 0.001). Of the 257 segments with baseline dyssynergy, adenosine echocardiography identified 122 segments as positive for viability, and 135 as necrotic since no improvement of systolic thickening was observed. Follow-up wall motion score index was 1.31 +/- 0.30 (p < 0.001 vs. rest). The sensitivity of adenosine echo test for identification of viable segments was 87%, while specificity was 95%, and diagnostic accuracy 90%. Positive and negative predictive values were 97% and 80%, respectively.

Conclusion: Low-dose adenosine stress echocardiography test has high diagnostic potential for detection of myocardial viability in the group of patients with left ventricle dysfunction due to previous myocardial infarction. Low dose adenosine stress echocardiography may be adequate alternative to low-dose dobutamine test for evaluation of myocardial viability.

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Diagnostic value of low dose adenosine stress echocardiography test in revascularized patients. Sn sensitivity, Sp specificity, Acc diagnostic accuracy.
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Figure 4: Diagnostic value of low dose adenosine stress echocardiography test in revascularized patients. Sn sensitivity, Sp specificity, Acc diagnostic accuracy.

Mentions: Successful coronary revascularization was done in 27 patients; echocardiographic follow-up examination was available in 24 (88%). Baseline echocardiography, before low dose adenosine testing, showed in these 24 revascularized patients a total of 122 dyssynergic segments. Regional wall motion improved at follow-up by ≥ 1 grade in 80 segments ("viable", 65%), whereas in the remaining 42 ("necrotic", 34%) no improvement could be observed. Of the 80 viable segments, adenosine correctly identified 70 (sensitivity 87%). Of the 42 necrotic segments adenosine correctly identified 40 (specificity 95%). The diagnostic accuracy of adenosine stress echocardiography in predicting the behavior of the basally dyssynergic myocardial segments after revascularization was 90%. Positive and negative predictive values were 97% and 80%, respectively (Figure 4). Wall motion score index improved significantly in revascularized patients during follow-up period (1.54 ± 0.28 vs. 1.31 ± 0.30, p < 0.01).


Low-dose adenosine stress echocardiography: detection of myocardial viability.

Djordjevic-Dikic A, Ostojic M, Beleslin B, Nedeljkovic I, Stepanovic J, Stojkovic S, Petrasinovic Z, Nedeljkovic M, Saponjski J, Giga V - Cardiovasc Ultrasound (2003)

Diagnostic value of low dose adenosine stress echocardiography test in revascularized patients. Sn sensitivity, Sp specificity, Acc diagnostic accuracy.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC161807&req=5

Figure 4: Diagnostic value of low dose adenosine stress echocardiography test in revascularized patients. Sn sensitivity, Sp specificity, Acc diagnostic accuracy.
Mentions: Successful coronary revascularization was done in 27 patients; echocardiographic follow-up examination was available in 24 (88%). Baseline echocardiography, before low dose adenosine testing, showed in these 24 revascularized patients a total of 122 dyssynergic segments. Regional wall motion improved at follow-up by ≥ 1 grade in 80 segments ("viable", 65%), whereas in the remaining 42 ("necrotic", 34%) no improvement could be observed. Of the 80 viable segments, adenosine correctly identified 70 (sensitivity 87%). Of the 42 necrotic segments adenosine correctly identified 40 (specificity 95%). The diagnostic accuracy of adenosine stress echocardiography in predicting the behavior of the basally dyssynergic myocardial segments after revascularization was 90%. Positive and negative predictive values were 97% and 80%, respectively (Figure 4). Wall motion score index improved significantly in revascularized patients during follow-up period (1.54 ± 0.28 vs. 1.31 ± 0.30, p < 0.01).

Bottom Line: Wall motion score index improved from rest 1.55 +/- 0.30 to 1.33 +/- 0.26 at low-dose adenosine (p < 0.001).Follow-up wall motion score index was 1.31 +/- 0.30 (p < 0.001 vs. rest).Positive and negative predictive values were 97% and 80%, respectively.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute for Cardiovascular Diseases, Dept. for Diagnostic and Catheterization Laboratories, Clinical Center of Serbia, 8 Koste Todorovica, 11000 Belgrade, Yugoslavia. skali@bitsyu.net

ABSTRACT

Objective: The aim of this study was to evaluate the diagnostic potential of low-dose adenosine stress echocardiography in detection of myocardial viability.

Background: Vasodilation through low dose dipyridamole infusion may recruit contractile reserve by increasing coronary flow or by increasing levels of endogenous adenosine.

Methods: Forty-three patients with resting dyssynergy, due to previous myocardial infarction, underwent low-dose adenosine (80, 100, 110 mcg/kg/min in 3 minutes intervals) echocardiography test. Gold standard for myocardial viability was improvement in systolic thickening of dyssinergic segments of >or= 1 grade at follow-up. Coronary angiography was done in 41 pts. Twenty-seven patients were revascularized and 16 were medically treated. Echocardiographic follow up data (12 +/- 2 months) were available in 24 revascularized patients.

Results: Wall motion score index improved from rest 1.55 +/- 0.30 to 1.33 +/- 0.26 at low-dose adenosine (p < 0.001). Of the 257 segments with baseline dyssynergy, adenosine echocardiography identified 122 segments as positive for viability, and 135 as necrotic since no improvement of systolic thickening was observed. Follow-up wall motion score index was 1.31 +/- 0.30 (p < 0.001 vs. rest). The sensitivity of adenosine echo test for identification of viable segments was 87%, while specificity was 95%, and diagnostic accuracy 90%. Positive and negative predictive values were 97% and 80%, respectively.

Conclusion: Low-dose adenosine stress echocardiography test has high diagnostic potential for detection of myocardial viability in the group of patients with left ventricle dysfunction due to previous myocardial infarction. Low dose adenosine stress echocardiography may be adequate alternative to low-dose dobutamine test for evaluation of myocardial viability.

Show MeSH
Related in: MedlinePlus