Key result
Revascularization linked to improved basal contraction in ~57% of infarct zones with prior contractile reserve.
Why the study?
Improvement in dysfunctional viable myocardium after revascularization is often less than expected from contractile reserve on dobutamine stress echocardiography, and the fate of contractile reserve without adequate contractile recovery is unknown.
Does revascularization improve contractile reserve in dysfunctional myocardium in postinfarction patients?
Observational (n=21)
Does revascularization improve contractile reserve in dysfunctional myocardium in postinfarction patients?
Revascularization maintains or increases contractile reserve in viable infarct zones, even those that do not fully recover basal function, contributing to functional improvement.
May identify viable zones likely to recover basal function post-revascularization; leaves open whether routine testing improves outcomes.
OBJECTIVES: We sought to investigate the effects of revascularization on the contractile reserve of dysfunctional myocardium. BACKGROUND: The improvement in dysfunctional but viable myocardium after revascularization is frequently less than expected from the amount of contractile reserve detected on dobutamine stress echocardiography. The fate of the contractile reserve, when it does not result in an adequate contractile recovery, is unknown. METHODS: Basal contraction and contractile reserve of infarct zones were assessed by dobutamine stress echocardiography in 21 postinfarction male patients before and > 3 months after revascularization (30 infarct zones; mean +/- SD left ventricular ejection fraction 35 +/- 8%). An infarct zone wall motion score index (WMSI) was calculated. RESULTS: Before revascularization, contractile reserve was present in 14 infarct zones (12 patients) and absent in 16 (9 patients). After revascularization, ejection fraction increased by 5 +/- 4% (p < 0.01) in patients classified as positive for contractile reserve and remained unchanged in those classified as negative. New York Heart Association classification improved in 58.3% and 22.2% of patients, respectively. Basal contraction improved in eight zones with previous contractile reserve (57.1%) and in one zone without (6.3%) (p < 0.01). Contractile reserve was still evident in 13 zones with previous contractile reserve (93%; 8 with contractile recovery), and it developed in 6 zones without (38%; none with contractile recovery). WMSI values after revascularization were decreased from values before revascularization during low dose dobutamine in zones with and without previous contractile reserve (p < 0.01 and < 0.05, respectively). CONCLUSIONS: After revascularization, contractile reserve is maintained or even increases in viable infarct zones that do not recover as expected. It may also develop in some infarct zones judged not to be viable before revascularization. This increased contractile reserve may play a role in the functional improvement of patients after revascularization.
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Lombardo et al. (1997) conducted an observational in Postinfarction with dysfunctional myocardium (n=21). Revascularization vs. Zones without previous contractile reserve was evaluated on Improvement in basal contraction of infarct zones (p=<0.01). Revascularization improved basal contraction in 57.1% of infarct zones with previous contractile reserve versus 6.3% of zones without prior reserve (p<0.01).
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