Related Experiment Videos
Dobutamine-induced hypoperfusion without transient wall motion abnormalities: less severe ischemia or less severe
A Elhendy1, M L Geleijnse, J R Roelandt
1Thoraxcenter, University Hospital Rotterdam, Dijkzigt, The Netherlands.
Journal of the American College of Cardiology
|February 1, 1996
Summary
Transient wall motion abnormalities are not indicative of less severe ischemia in coronary artery disease patients undergoing dobutamine MIBI SPECT. The study found similar defect severity regardless of wall motion abnormalities, suggesting mechanically silent ischemia is not a marker of milder disease.
Area of Science:
- Cardiology
- Nuclear Medicine
- Diagnostic Imaging
Background:
- Reversible perfusion defects in coronary artery disease (CAD) without wall motion abnormalities were presumed to indicate less severe ischemia.
- Limited data exist to substantiate this assumption regarding ischemia severity.
Purpose of the Study:
- To compare clinical characteristics, hemodynamic response, and ischemia severity in CAD patients with reversible perfusion defects on dobutamine MIBI SPECT.
- To determine if transient wall motion abnormalities (TWMA) correlate with ischemia severity in these patients.
Main Methods:
- Fifty-four CAD patients with reversible defects on dobutamine MIBI SPECT underwent simultaneous echocardiography.
- Myocardial segments were analyzed, and quantitative ischemic perfusion scores were derived.
- Patients were categorized based on the presence (Group A) or absence (Group B) of TWMA.
Main Results:
- Forty patients (74%) had TWMA (Group A), while 14 (26%) did not (Group B).
- No significant differences were found in age, prior myocardial infarction, number of abnormal coronary arteries, number of defects, or ischemic perfusion scores between groups.
- Group A exhibited a higher prevalence of male gender, higher peak systolic blood pressure, higher peak rate-pressure product, and increased angina and ST depression compared to Group B.
Conclusions:
- Absence of TWMA in dobutamine MIBI SPECT for CAD patients is associated with similar ischemia extent and severity.
- Patients without TWMA had lower stress rate-pressure product and a higher prevalence of female gender.
- Mechanically silent ischemia on myocardial perfusion scintigraphy should not be interpreted as a sign of less severe ischemia.