Accuracy and safety of low-dose dobutamine stress echocardiography early after acute anterior myocardial infarction

Abstract

Objectives: We sought to explore the safety and prognostic accuracy of low-dose dobutamine stress echocardiography (DSE), performed early in the course of acute anterior ST elevation myocardial infarction (STEMI), in patients who received thrombolytic therapy.Methods: We enrolled 73 consecutive patients presenting with first acute anterior STEMI, who had significant coronary stenosis/occlusion of the culprit artery amenable for revascularization. Low-dose DSE was performed within 2-7 (3.8 ± 1.8) days of the index hospitalization. Patients underwent coronary revascularization. Follow-up echocardiography was performed 2-3 months after revascularization to assess regional wall motion abnormality. Predicted viability by low-dose DSE was compared with actual contractility improvement seen at follow-up echocardiography.Results: Considering a per-patient analysis, low-dose DSE early after anterior STEMI predicted viability with a sensitivity of 88.9%, specificity of 75.7%, PPV of 78%, NPV of 87.5%. Based on a per-segment analysis, low-dose DSE achieved a sensitivity of 86.9%, specificity of 92.5%, PPV of 73.2%, NPV of 96.8%. Based on a per-segment analysis performed individually for hypokinetic segments, low-dose DSE achieved a sensitivity of 88%, specificity of 85.4%, PPV of 74%, NPV of 93.8%. For akinetic segments, low-dose DSE achieved a sensitivity of 82.4%, specificity of 97%, PPV of 70%, NPV of 98.5%.Conclusion: Low-dose DSE performed early in patients presenting with acute anterior STEMI who received thrombolytic therapy, is safe with a high sensitivity but a modest specificity for predicting contractile improvement after revascularization, based on a per-patient analysis. However, based on a per-segment analysis, both sensitivity and specificity are high