Effect of gender on the prognostic value of dobutamine stress myocardial contrast echocardiography

Low-dose dobutamine stress myocardial contrast echocardiography for evaluating myocardial microcirculation perfusion and predicting long-term prognosis in ST-segment elevation myocardial infarction after percutaneous coronary intervention

OBJECTIVE

Percutaneous coronary intervention (PCI) can effectively restore myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, STEMI patients may still experience a "no-reflow" phenomenon after PCI. Accordingly, this study focused on the clinical value of low-dose dobutamine stress myocardial contrast echocardiography (MCE) for evaluating myocardial microcirculation perfusion and long-term prognosis in STEMI patients after PCI.

METHODS

This study included 70 STEMI patients receiving PCI. Low-dose dobutamine stress MCE was performed to detect viable myocardium at 72 h after PCI and quantitatively analyze myocardial microcirculation perfusion at 72 h and 6 months after PCI. Patients were categorized into dobutamine stress echocardiography (DSE)-positive and DSE-negative groups, followed by comparisons of LVEF. The 3-year survival of STEMI patients after PCI was analyzed.

RESULTS

No adverse reactions occurred during low-dose dobutamine stress MCE. Low-dose dobutamine stress MCE effectively detected viable myocardium at 72 h after PCI (AUC: of 0.849). Under the basal or stress state, A, β, and A × β values of viable myocardium at 6 months after PCI were prominently higher than values at 72 h after PCI. A and A × β values of viable myocardium at 6 months after PCI were considerably higher in the stress state than in the basal state. LVEF and long-term survival rates after PCI were markedly higher in the DSE-positive group than in the DSE-negative group.

CONCLUSION

Low-dose dobutamine stress MCE is an effective evaluation method for myocardial perfusion, left ventricular function recovery, and poor long-term prognosis in STEMI patients after PCI.

Low-dose dobutamine stress myocardial contrast echocardiography for the evaluation of myocardial microcirculation and prediction of overall cardiac function recovery

The study aimed to investigate the role of low-dose dobutamine stress myocardial contrast echocardiography (MCE) in evaluating myocardial local microcirculation and predicting cardiac function recovery in patients with myocardial infarction. A total of 50 patients with acute myocardial infarction (AMI) were enrolled in the present study. Positron emission tomography was used as a gold standard to determine viable/non-viable myocardial segments in infarcted myocardial region. MCE and dobutamine stress MCE were carried out 72 h after PCI. MCE was carried out again to evaluate myocardial condition at 6 months after PCI. As compared with normal myocardial segments, resting MCE revealed a significant decrease of the values of A (the peak intensity of the time-perfusion intensity curve, reflecting the myocardial blood volume), β (the slope of the curve, reflecting the myocardial blood flow (MBF) velocity) and A x β (reflecting MBF) of viable and non-viable myocardial segments. After being challenged by dobutamine, the values of A, β and A x β of normal coronary blood supply areas were significantly increased; while the segments A and A x β of viable myocardium were markedly decreased. Patients were further divided into two groups based on the changes in the contrast-enhanced index (CSI) following dobutamine loading. In the dobutamine stress echocardiography-positive group (the CSI increased or decreased by >0.2), the left ventricular ejection fraction was significantly increased and pro-B-type natriuretic peptide significantly decreased at 6 months following intervention. Low-dose dobutamine stress MCE was indicated to be an effective method to evaluate myocardial microcirculation perfusion in patients with AMI following PCI. In addition, CSI, as a simple semi-quantitative index, may predict left ventricular function in patients with AMI.

Utility of Imaging in Risk Stratification of Chest Pain in Women

OPINION STATEMENT

Recent decades have seen a growing recognition that the understanding of sex differences in cardiovascular disease (CVD) is vital to optimal diagnosis and management, particularly of women (Mosca et al. Circulation 124:2145-54, 2011). There is simultaneously an increasing appreciation of the multifactorial nature of ischemic heart disease (IHD) in many patients, in whom disease may extend beyond the epicardial coronaries. While obstructive coronary artery disease (CAD) remains underdiagnosed in women and still represents a major burden of disease, women also present with nonobstructive CAD more commonly than men (Patel et al. N Engl J Med 362:886-95, 2010). Indeed, microvascular dysfunction, coronary artery vasospasm, and coronary dissections contribute to a larger proportion of IHD in women than men (Bairey Merz et al. J Am Coll Cardiol 47:S21-9, 2006). Here, we review the symptom presentation of women with IHD and the noninvasive modalities used to risk stratify women with suspected IHD.