ABSTRACT
The purpose of this research was to study the effect of dobutamine on left ventricular [LV] filling indices in patients suffering their first uncomplicated Acute myocardial infarc-tion restricted to the inferior wall of the LV [AMI-1], and to determine whether restrictive filling pattern [RFP] at peak stress has prognostic value and its utility for evaluation of CAD. METHODS: A total of 40 patients with uncomplicated inferior wall AMI were studied by Doppler echocardiography at rest and stress; RFP was defined as transmitral E:A ratio > or =1.0, isovolumic relaxation time [IRT] <80 ms, and E-wave deceleration time [Edt] <120 ms. A total of 24 of 40 had RPP at rest, which reverted to non-RFP at stress in 11 [group 2], but persisted in 13 [group 1]; 16 of 40 had non-RFP at rest and peak stress [group 3]. Systolic, diastolic and mean blood pressures were significantly decreased in group [1] compared to group [2] and group [3]. Congested neck veins and lung fields were significantly increased in group [1] compared to group [2] and group [3], and also in group [2] compared to group [3]. LVEDD and LVESD were significantly increased, while LVFS and LVEF were significantly decreased in group [1] compared to group [2] and group [3]. E wave and E/A ratio were significantly increased, while Edt, IRT and Tei index were significantly decreased in group [1] and group [2] compared to group [3], with no significant difference between group [1] and group [2]. CK and CKMB were significantly increased in group [1] compared to group [2] and group [3], and also in group [2] compared to group [3]. In addition, CRP and troponin T were significantly increased in group [1] compared to group [2] and group [3]. Post infarction angina, heart failure and conduction defects were significantly increased in group [1] compared to group [2] and group [3]. Arrhythmia were significantly increased in both group [1] and [2] compared to group [3], with no significant difference between group [1] and group [2].Three vessel disease was statistically more prevalent in group [1] compared to group [2] and group [3]. On the other hand, single vessel disease was statistically more prevalent in group [3] compared to group [1] and group [2]. LAD and LCX lesions were statistically more prevalent in group [1] compared to group [2] and group [3]. In patients suffering inferior infarction, persistence of restrictive filling during stress implies an important marker for increased morbidity and mortality. Stress echocardiography uniquely identifies those high-risk patients