No abstract available.
Dobutamine* ; Echocardiography, Stress* ; Myocardium*

No abstract available.
Adenosine* ; Dipyridamole* ; Dobutamine* ; Exercise Test*

No abstract available.
Dobutamine ; Echocardiography, Stress ; Liver Transplantation ; Liver

No abstract available.
Coronary Artery Disease* ; Coronary Vessels* ; Diagnosis* ; Dobutamine* ; Echocardiography, Stress*

No abstract available.
Coronary Stenosis* ; Coronary Vessels* ; Dobutamine* ; Echocardiography, Stress* ; Female ; Humans

OBJECTIVETo evaluate the value of low-dose adenosine echocardiography (LDAE) for detection of myocardial viability in patients with acute myocardial infarction (MI).

METHODSThirty-six patients underwent LDAE within 3 - 10 days after onset of first acute MI before (n = 4) or after (n = 32) percutaneous coronary intervention. A 17-segment semi-quantitative scoring model was adopted. Wall motion improvement derived from two dimensional images at follow-up (2 - 3 months after acute MI) comparing baseline before adenosine infusion was used as gold criteria for myocardial viability.

RESULTSLow-dose adenosine slightly increased heart rates [(70.7 +/- 10.8) beats/min vs. (78.1 +/- 10.9) beats /min, P < 0.01] and also significantly reduced left ventricular endsystolic volume [(30.4 +/- 1.9) ml vs. (20.1 +/- 9.3) ml, P < 0.01] and increased ejection fraction (62.6% +/- 10.4% vs. 74.7% +/- 9.8%, P < 0.01). The sensitivity, specificity, diagnostic accuracy, positive and negative prective values of LDAE for identification of viable myocardium were 90.3%, 80.8%, 86.0%, 84.8% and 87.5%, respectively. Incidence of mild adverse reaction during LDAE was 38.9% (14/36). LDAE at dose of 100 microgxkg(-1)xmin(-1) was ideal in terms of balanced sensitivity and specificity for detecting viable myocardium without increasing the adverse effects compared to lower doses.

CONCLUSIONSLDAE (100 microgxkg(-1)xmin(-1)) has excellent sensitivity and specificity for detecting viable myocardium in acute MI with only minimal adverse effects.

We studied to investigate the predictive values of gated SPECT for the improvement of wall motion after bypass surgery. As we compared postoperative SPECT with preoperative ones, we defined viability as wall motion improvement. We performed rest 71-201/stress Tc-99m-MIBI gated SPECT in 25 patients before and 3 months after bypass surgery. Myocardial wall motion was graded as normal, hypokinesia, akinesia, and dyskinesia by pair-wise visual analysis of gated pre and postoperative SPECT's on the same monitor screen. Myocardial wall thickening was determined good or poor Among 92 segments with wall motion abnormalities before operation, 69 (75%) improved and 23 did not. Before operation, we could find segments with good systolic thickening in 64 segments among total 92. Thickening of the remaining 28 was poor. Wall motion improved postoperatively in 45 segments (70%) among 64 with good thickening. Twenty four(86%) among 28 segments with poor thickening had also improved. We grouped segments into mild(hypokinetic) and severe(akinetic/dyskinetic) ones. Among 33 segments with severe motion abnormalities, 14 had good thickening and 19 did not. Nine(60%) improved out of 14 segments having severe abnormality with good thickening. However, 16(84%) segments out of 19 having severe abnormality with poor thickening also improved. Neither degree of perfusion decrease nor severity of wall motion abnormalities could explain the high rate of false negatives. In conclusion, as we defined viability as wall motion improvement by comparing pre and postoperative SPECT, systolic thickening observed by gated Tc-99m-MIBI SPECT in myocardial segments with wall motion abnormalities predicted wall motion improvement after bypass surgery. However, poor thickening could not be referred as evidence of nonviable myocardium both in mild and severe contractile dysfunction, so that we might need stimulation study such as dobutamine echocardiography or dobutamine gated SPECT.
Dobutamine ; Dyskinesias ; Echocardiography ; Humans ; Hypokinesia ; Myocardium ; Perfusion ; Tomography, Emission-Computed, Single-Photon*

BACKGROUND AND OBJECTIVES: Doppler myocardial imaging (DMI) has been suggested as a method of quantifying inducible ischemia during dobutamine stress echocardiography (DSE). Post-systolic motion (PSM) detected by DMI is related to peri-infarct ischemia during DSE. We hypothesized that PSM during DSE would predict recovery of dysfunctional myocardium after successful percutaneous coronary intervention (PCI). SUBJECTS AND METHODS: Thirty patients with dysfunctional myocardium in the left anterior descending coronary artery (LAD) territory were divided into two groups according to improvement of wall motion score index (WMSI) in the LAD territory at 6 months after successful PCI of the LAD. DMI was evaluated in the LAD territory during DSE. Fifteen patients showed improved WMSI (1.42+/-0.39) while the other 15 had unchanged WMSI (1.75+/-0.46) 1 month after PCI. Myocardial velocity was measured in the mid-septal, apico-septal, and basal anterior segments of the LAD artery territory. PSM was defined as a positive wave appearing after the curve of systolic ejection had reached the zero line. RESULTS: Although there was no difference between resting PSMs in both groups, PSM during DSE was significantly higher in the improved WMSI group than in the WMSI group where it was unchanged. CONCLUSION: PSM during DSE predicts recovery of dysfunctional myocardium after successful PCI.
Arteries ; Coronary Vessels ; Dobutamine ; Echocardiography, Stress ; Humans ; Ischemia ; Myocardial Stunning ; Myocardium ; Percutaneous Coronary Intervention

> BACKGROUND: The accuracy of flow-related changes in aortic valve area (AVA) determined by the Gorlin formula or the continuity equation remains disputable. However, anatomic AVA can be determined by using by direct planimetry of transesophageal echocardiography (TEE). The purpose of this study was to assess the impact of changes in flow on AVA determined by TEE using direct planimetry. METHOD: Determination of AVA by TEE using direct planimetey was performed intraoperatively under three different hemodynamic conditions - pre-dobutamine (baseline) period, post-dobutamine period, post-CABG period - in 17 CABG patients and cardiac output (CO) with left ventricular ejection fraction (EF) were also determined by TEE simutaneously. The changes in aortic flow were induced by dobutamine infusion. RESULTS: AVA at pre-dobumaine period, post-dobutamine period, and post-CABG period were 2.99+/-0.80 cm2, 3.01+/-0.79 cm2, and 3.01+/-0.80 cm2, respectively. Before dobutamin infusion, CO and EF were 2.01+/-0.64 L/min and 47+/-10%. After dobutamine infusion, CO and EF were 3.03+/-1.05 L/min, 54+/-9% respectively and significantly increased by 54%, 18% than those measured before dobutamine infusion (p<0.01, p<0.01), respectively. After CABG, CO and EF were 3.86+/-1.86 L/min and 58+/-11% and also significantly increased by 98%, 26% than those measured before dobutamine infusion (p<0.01, p<0.01), respectively. However, despite of these significant hemodynamic changes, there were no significant changes in AVA and no significant correlations between these hemodynamic and AVA changes, neither at post-dobutamine period nor post-CABG period. CONCLUSION: The acute changes in CO and EF do not result in significant alterations in the anatomic AVA determined by TEE using direct planimetry. Thus, TEE using direct planimetry could be accurate and useful in the determination of AVA in hemodynamically unstable patient.
Aortic Valve* ; Cardiac Output* ; Dobutamine ; Echocardiography, Transesophageal* ; Hemodynamics ; Humans ; Stroke Volume*

> BACKGROUND: The accuracy of flow-related changes in aortic valve area (AVA) determined by the Gorlin formula or the continuity equation remains disputable. However, anatomic AVA can be determined by using by direct planimetry of transesophageal echocardiography (TEE). The purpose of this study was to assess the impact of changes in flow on AVA determined by TEE using direct planimetry. METHOD: Determination of AVA by TEE using direct planimetey was performed intraoperatively under three different hemodynamic conditions - pre-dobutamine (baseline) period, post-dobutamine period, post-CABG period - in 17 CABG patients and cardiac output (CO) with left ventricular ejection fraction (EF) were also determined by TEE simutaneously. The changes in aortic flow were induced by dobutamine infusion. RESULTS: AVA at pre-dobumaine period, post-dobutamine period, and post-CABG period were 2.99+/-0.80 cm2, 3.01+/-0.79 cm2, and 3.01+/-0.80 cm2, respectively. Before dobutamin infusion, CO and EF were 2.01+/-0.64 L/min and 47+/-10%. After dobutamine infusion, CO and EF were 3.03+/-1.05 L/min, 54+/-9% respectively and significantly increased by 54%, 18% than those measured before dobutamine infusion (p<0.01, p<0.01), respectively. After CABG, CO and EF were 3.86+/-1.86 L/min and 58+/-11% and also significantly increased by 98%, 26% than those measured before dobutamine infusion (p<0.01, p<0.01), respectively. However, despite of these significant hemodynamic changes, there were no significant changes in AVA and no significant correlations between these hemodynamic and AVA changes, neither at post-dobutamine period nor post-CABG period. CONCLUSION: The acute changes in CO and EF do not result in significant alterations in the anatomic AVA determined by TEE using direct planimetry. Thus, TEE using direct planimetry could be accurate and useful in the determination of AVA in hemodynamically unstable patient.
Aortic Valve* ; Cardiac Output* ; Dobutamine ; Echocardiography, Transesophageal* ; Hemodynamics ; Humans ; Stroke Volume*