Low-dose adenosine stress echocardiography: detection of myocardial viability
Ana Djordjevic-Dikic1, Miodrag Ostojic, Branko Beleslin
1Institute for Cardiovascular Diseases, Dept. for Diagnostic and Catheterization Laboratories, Clinical Center of Serbia, 8 Koste Todorovica, 11000 Belgrade, Yugoslavia. skali@bitsyu.net
Insights
Low-dose adenosine stress echocardiography effectively detects myocardial viability in patients with left ventricle dysfunction post-myocardial infarction. This method shows high accuracy, offering a potential alternative to dobutamine stress tests for assessing heart muscle viability.
Area of Science:
- Cardiology
- Diagnostic Imaging
- Myocardial Viability Assessment
Background:
- Myocardial infarction can lead to left ventricle dysfunction and resting dyssynergy.
- Assessing myocardial viability is crucial for guiding treatment decisions, such as revascularization.
- Pharmacological stress agents like adenosine can be used to evaluate contractile reserve.
Purpose of the Study:
- To evaluate the diagnostic accuracy of low-dose adenosine stress echocardiography for detecting myocardial viability.
- To compare the effectiveness of low-dose adenosine echocardiography with established methods for viability assessment.
Main Methods:
- Forty-three patients with post-myocardial infarction left ventricle dysfunction underwent low-dose adenosine stress echocardiography.
- Myocardial viability was defined as improvement in systolic thickening of dyssynergic segments.
- Follow-up echocardiography and coronary angiography were utilized to assess outcomes and correlate findings.
Main Results:
- Low-dose adenosine stress echocardiography demonstrated high diagnostic accuracy (90%) for identifying myocardial viability.
- The test showed high sensitivity (87%) and specificity (95%) in detecting viable myocardial segments.
- Wall motion score index significantly improved during adenosine stress, indicating enhanced contractile function.
Conclusions:
- Low-dose adenosine stress echocardiography is a valuable tool for assessing myocardial viability in patients with left ventricle dysfunction.
- This technique offers a high diagnostic potential and may serve as an alternative to low-dose dobutamine stress testing.
Objective:
The aim of this study was to evaluate the diagnostic potential of low-dose adenosine stress echocardiography in detection of myocardial viability.
Background:
Vasodilation through low dose dipyridamole infusion may recruit contractile reserve by increasing coronary flow or by increasing levels of endogenous adenosine.
Methods:
Forty-three patients with resting dyssynergy, due to previous myocardial infarction, underwent low-dose adenosine (80, 100, 110 mcg/kg/min in 3 minutes intervals) echocardiography test. Gold standard for myocardial viability was improvement in systolic thickening of dyssinergic segments of >or= 1 grade at follow-up. Coronary angiography was done in 41 pts. Twenty-seven patients were revascularized and 16 were medically treated. Echocardiographic follow up data (12 +/- 2 months) were available in 24 revascularized patients.
Results:
Wall motion score index improved from rest 1.55 +/- 0.30 to 1.33 +/- 0.26 at low-dose adenosine (p < 0.001). Of the 257 segments with baseline dyssynergy, adenosine echocardiography identified 122 segments as positive for viability, and 135 as necrotic since no improvement of systolic thickening was observed. Follow-up wall motion score index was 1.31 +/- 0.30 (p < 0.001 vs. rest). The sensitivity of adenosine echo test for identification of viable segments was 87%, while specificity was 95%, and diagnostic accuracy 90%. Positive and negative predictive values were 97% and 80%, respectively.
Conclusion:
Low-dose adenosine stress echocardiography test has high diagnostic potential for detection of myocardial viability in the group of patients with left ventricle dysfunction due to previous myocardial infarction. Low dose adenosine stress echocardiography may be adequate alternative to low-dose dobutamine test for evaluation of myocardial viability.
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