Accuracy of low dose dobutamine echocardiography in detection of myocardial viability experience of menofia university

The identification of severely dysfunctional but viable myocardium is of particular importance for the selection of patients with depressed left ventricular function who will benefit from coronary revascularization. Assessment of inotropic reserve with dobutamine has recently been used for this purpose. Aim of the Study: Detecting the accuracy of low-dose dobutamine echocardiography [DSE] for the identification of viable myocardium in patients with previous myocardial infarction. Resting and low-dose dobutamine [7.5ag/kg/min] echocardiography [R and DSE] and resting post-revascularization echocardiography [PRecho] [3 months later] were prospectively studied in 33 patients with previous myocardial infarction and severely depressed regional function. Revascularization had been done either by CABG or PTCA for all patients. Wall motion assessment was done using 4 point score with 1 normal and 4 dyskinetic and viable tissue was diagnosed by presence of contractile response [CR] during LDD infusion in echocardiography using 17 segment model. Out of the 561 myocardial segments resting echo [IR] revealed 367 segments with normal wall motion [NWM], 109 hypokinetic with [CR] in 83, 52 akinetic with [CR] in 24,33 dyskinetic with CR in 3. Post-revascularization echo. revealed 476 segments with NWM, 26 hypo, 28 ak., and 30 dyskinetic. Compared to PR DSE., degree of matching was S5.6%. Sensitivity and specificity for detection of viability was 79.6% and 100% respectively. DSE can be used accurately for detection of clinical viability and predicting early functional recovery post-revascularization.

Relation between left ventricular mass index [LVMI] and coronary artery disease in hypertensive patients with left ventricular hypertrophy [LVH]

It has been reported that coronary flow reserve decreased in nearly all patients when left ventricular mass index [LVMI] become 50% its normal values. Aim of Study: Correlation between LVMI, exercise ECG and coronary angiography findings to determine timing of catheterization in ischemic hypertensive patients. Three hundred and eight seven patients had been divided into group I with no hypertension including 195 cases, and group II with hypertension and included 192. The latter group had been subdivided into hypertensive with no left ventricular hypertrophy [LVH] 83/192 group IIa, and hypertensive with LVH 109/192 group IIb. This group IIb has been subdivided again into group IIbl with LVMI <20% 23 cases, group IIb2 with LVMI 20-<50% 13 cases and group IIb3 with LVMI 50% and including 73 cases. All cases had been subjected to clinical assessment, non-invasive assessment [resting ECG, exercise ECG, and Echocardiogram] and invasive test [coronary angiography]. Group I revealed 135 cases [69.3%] while group II showed 126 [65.6%] with CAD. The highest prevalence of CAD was observed in group IIb3. Stress ECG could detect CAD in group I with sensitivity of 53.3% versus 69.8% in group II [p=0.05] and speeificity of 90% versus 78.8% respectively with p<0.05