2014


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2014/№2

Comparison of longitudinal myocardial deformation values at rest and results of low-dose dobutamine stress-echocardiography for identification of viable myocardium in patients with postinfarction cardiosclerosis

Gilyarov M. Yu., Murashova N. K., Novikova N. A., Sedov V. P., Syrkin A. L.
State Budgetary Educational Institution “I. M. Sechenov First Moscow State Medical University” of the RF Ministry of Health Care, Trubetskaya 8, Bld. 2, Moscow 119991

Keywords: diagnostics, dobutamine stress-EchoCG, myocardial infarction, postinfarction cardiosclerosis

DOI: 10.18087/rhj.2014.2.1910

Background. A promising method for detecting hibernating myocardium is evaluation of myocardial deformation at rest. Aim. To compare the significance of segmental longitudinal myocardial deformation with results of low-dose dobutamine stress-EchoCG for detection of viable myocardium in patients with postinfarction cardiosclerosis. Materials and methods. 25 patients with postinfarction cardiosclerosis and impaired local contractility were evaluated. The patients were men aged 41 to 73 years (median age, 57 years) who were hospitalized for coronary bypass surgery. Standard EchoCG, low-dose dobutamine stress-EchoCG according to a standard protocol, and EchoCG with speckle tracking for identification of myocardial longitudinal deformation were performed for all patients. Longitudinal deformation values corresponding to positive and negative values of the test for identification of viable myocardium were evaluated. Results. Myocardial viability was evaluated for 165 segments including 68 (41.2 %) segments which responded to low-dose dobutamine with increased contractility. Mean value of myocardial deformation before revascularization was –8.1±4.4 (consistent with hypokinesia according to our data) in dobutamine-responsive segments and –4.9±5 (consistent with akinesia according to our data) in non-responsive segments (р<0.01). Ratios of longitudinal deformation values at rest to the positive response to low-dose dobutamine stress-EchoCG in areas of impaired local contractility were analyzed using the ROC curve. At the deformation value of –6.5, a positive response to the dobutamine test showed specificity of 63 % and sensitivity of 85 %. Conclusion. Values of segmental longitudinal myocardial deformation at rest lower than –6.5 predict a positive result of low-dose dobutamine stress-EchoCG for identification of viable myocardium in the area of locally impaired contractility.
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Gilyarov M. Yu., Murashova N. K., Novikova N. A. et al. Comparison of longitudinal myocardial deformation values at rest and results of low-dose dobutamine stress-echocardiography for identification of viable myocardium in patients with postinfarction cardiosclerosis. Russian Heart Journal. 2014;76 (2):81–84

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