Dobutamine stress echocardiography in the monitoring of post-angioplasty myocardial contraction and in detection of restenosis
Paczek, A.; Michałek, P.; Rydlewska-Sadowska, W.
Polskie Archiwum Medycyny Wewnetrznej 97(4): 316-322
1997
PMID: 9411408 Document Number: 6575
The expanding role of percutaneous transluminal coronary angioplasty (PTCA) in the selected patients with coronary artery disease (CAD), requires the noninvasive method for the assessment of the influence of PTCA on left ventricular function and the detection of restenosis. Forty two patients (pts) with angina, undergoing PTCA, were evaluated with dobutamine stress echocardiography (DSE) 1 day before, 2-7 days after, 3-4 months and 1 year after successful angioplasty. Two-dimensional echocardiographic images were collected during incremental doses of intravenous dobutamine infusion (up to 40 micrograms/kg/min). In 31.7% of examinations atropine was added (0.5-1 mg). Echocardiograms were assessed at baseline and during low- and high-dose of dobutamine infusion. An echocardiographic test positive for restenosis was defined as showing a new wall motion abnormality induced by dobutamine 3-4 months or 1 year after PTCA, compared to DSE 2-7 days after PTCA. Whereas before angioplasty, the wall motion score index (WMSI) increased from 1.40 +/- 0.34 at rest to 1.56 +/- 0.34 at peak stress (p < 0.0001); after angioplasty WMSI decreased from 1.29 +/- 0.30 at rest to 1.24 +/- 0.28 at peak (p < 0.0001). In 20 patients control angiography (CA) was performed because of positive DSE (11/20) or for clinical reasons only (9/20). In this selected group CA showed significant restenosis in 10 patients with high DSE sensitivity and specificity, 83% and 91% respectively. In this group peak stress WMSI increased from 1.21 just after PTCA to 1.60 during the examination detecting restenosis (p < 0.01). 1. A reduction in myocardial ischaemia, as assessed by DSE, is seen early after angioplasty. 2. Serial DSE records changes in regional function, thus being a valuable tool in PTCA follow up.
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