Califf, Robert M.

Kesler, Karen L.

Peterson, Eric D.

Shaw, Leslee J.

Elsevier - Publisher Connector 

JACC February 1996 ABSTRACTS-Oral 329A 
spenses ('oiphasic and scar with ischomia) were predictive of adverse out- 
come. Revascufadzation may Improve outcome in these patients. In con- 
dusicn, Jschemla, rather than scar, by DSE predicts adverse outcome in 
patients with ohronlo left ventrioJTar clysfunc'don. 
4:30 
raT~ Extent Myocardlum by Dobutamlne of Nonviable 
Echo¢ardlography Predicts Death In Ischemlc 
Cardlomyopathy 
William V. Novak, Stephen G. Sawada, Stephen J. Lewis, Judy Foltz, 
Patrida Brenneman, John R. Bates, Douglas S. Segar, 
Harvey Feiganbaum. Indiana Universe, Ind/anapolls, IN 
Dobutamine Edaocardlegrephy (DE) has been shown to be useful for distin- 
guishing viable from nonviable myoeardium, but the value of DE for pr~clicting 
prognosis in ischemic cardiomyepathy (CADCM) ia unknown. Fifty-three pa- 
tients (pts) with CADCM underwent low (10 meg/k~min) and peak-dese 
DE. Left ventricular wall motion was assessed using a 16 segment model 
and Wall Motion Score 0NMS) indices were calculated for each pt. Aldnetic 
segments that did not improve with Oobufamtne were considered nonviable. 
In an average of 21 months of follow-up, 13 of the 53 (25%) pts had car- 
dlao deaths. In those who died, an average of 50 4- 24% of segment,= were 
nonviable. In the remaining 40 pts, an average of 25:1: 17% of segments 
were nonviable (p < 0.001). Deaths occurred in 13 of 39 (33%) pts with > 
3 nonviable segments and in none of the 14 (0%) lOtS with < 3 nonviable 
segments (p = 0.012). A low-dose WMS index >_ 1.9 had 100% sensitivity (13 
of 13 pts) and 35% positive predictive value (13 of 37 pts) for iden~lylng pts 
with cardiac death. A low-dose WMS ind~:'~ --J~Q had a negative predictive 
value of 100% (16of 16 pts). 
Conclusions: 1) In this study, pts with CADCM who died had twice the 
extent of nonviable myocardium by DE as those who lived. 2) Pts at high risk 
for cardiao death were identified by > 3 nonviable segments or a icw-doea 
WMS index >_. 1.9. 3) Pts at low risk for cardiac death were identified by < 3 
nonviable segments or a low-dose WMS index < 1.9. 
4:45 
[ -~- ]  Prognost lc o f  Low-Dose Oobutamlne Significance 
Test in Patients With Advanced Conge~llve Heart 
Fai lure Due to Dilsted Cardiomyopathy 
Mass!me Pozzoli, Socoomo Capomatla, Giovanni Cioifi, Egidio Travaral, 
Mariefla Franchinl, France Coballi, Luigl Tavazal. Mauger/ 
Foundaffon-IRCCS, Montescano (Pavia) - -  Italy 
Indices of systolic cardiac performance at rest provide limited prognostic 
information in patients (10is) with advanced congestive heart failure due to 
dilated cardiomyopathy. To evaluate the pregnestJc significance of the re- 
spense to inotropic stimulation, 77 pts with congestive heart failure and 
dilated cardiomyopathy (46 ischemic and 26 non-ischemlc) undenvant si- 
multaneous dght heart catheterization and 2D echocardicgraphy at baseline 
and during low-dose (10 y/kg/min) dobutamine (DOB) infusion. Thermodflu- 
tion cardiac index ((31) and cardiac power output (W) were measured by tight 
catheterization, From 2D-echcoardingraphy left ventricular ejection frecticn 
(EF) and a semklua.~;tative wall motion score Index 0NMSI) were calculatsd. 
Results: dudng a mean follow-up of 17 4- 9 months, 27 pts died, 
Ct (I/m/nQ) W (watts) EF (%) WMSI 
Rest DOB Rest DOB Rest DOB Rest 0OB 
Survivors 2.2¢-0.5 3.2¢-0.6 0.9-~-0.3 1.2¢-0.4 24¢-6 33=1:10 2.6-J:0.2 2--'-0.2 
(5opte) , 
Non-survivors 2.0¢-0.5 2.8¢--6 0.8:L-0.3 0.9-~0.3 23=1:7 27~-I~ 2.9£-0.3 2.8~.5 
R;'pts) . . . . . .  
*p < 0.05. **p < 0.02 
Conc/us/ons: In lots with advanced congestive heart failure due to dilated 
cardtomyopathy, low-dose DOB test shows that non-survivona dudng a mid- 
term follow-up have similar systolic function at rest but lower contxac~le 
reserve than survivors. 
Exerc i se  Phys io logy  and  Test ing Ill 
Wednesday,  March 27, 1996, 4:00 p.m.-5:00 p.m. 
Orange County Convent ion Centor, Room 224B 
4:00 
~ - 1  Are Stress Imaging Modalltles of Value In 
Pest-Myocardial In far~lon Predischarge Risk 
~t ;~cat ion?  A Mete-Analysis o f  Stress Parfueion 
and Vantrleular Function Imaging Studies 
Lealea J. Shaw, Edc D. Patercon, Karen L Kasler, Robert M. Catiff, Duke 
Noninvasive Research Working Group. Duke Univarsi~Medical Canter, 
Durham, NO 
Specialized post-myocardial infarction (MI) predischarge testing includes 
exercise (EX) or pharmacologic atmss (Pharm) pedusicn (MPI), radlonuclide 
angiegrephy (RNA), or echocardicgrapby. To examine the predictive value 
of imaging modallties post-MI for cardiac death (D) or MI, we reviewed 
MEDLINE from 1980 to 1994; procludng 13 MPI (EX = 8, Phon~ = 5), 6 Echo 
(EX = 2, Pllarm = 4) and 8 EX RNA reports on 4,350 patients (mean ~ge:56 
years;85% male) tested 1.2-2.8 weeks pest-Ml. Overall O or MI rates at 1.5 
years ranged from 8"/o to 23%. 
D or MI Rates by Test Resu11 Summa.,y O(~'s 
Abnormal, %(n) Non.a1, %{n) Ratio (95% C.t.) 
F.X Per~.~on 
ReversJ~e Defect 15.8%(417) 6.1%{335) 3.6(1.2,12.6) 
Multiple Defects 16.7%(36) 2.0%(99) 3.3(1.2,11.1) 
Phann ~ 
Rever~'ble Defect 19.S%(154) 9.1%(132) 1.8(0.8. 4 1) 
Mufllple Defects 16.7%(12) 10.0%(20) 1.8(0.8.11.8) 
EXRNA 
Ejec~on FrsctJon _< 40% 31.0%(29) 9.1%{66) 4.4(1 .'7.14.0) 
Ejection Frsction & < 5% 18.2%(99) 6.2%(243) 3.6(1.3, 9.9) 
New Dyssynergy 17.1%(82) 5.6%(71) 2.7(1.2, 6.4) 
EX C-ch~a~ra~ 
Ejection Fraction J < 5% ~..S%(18) 7.8%(51) 9.1(2.2.37.7) 
New Dyswnergy 48.5"%(33) 13.5%(74) 8.6(2.7, 27.6) 
P~arm 
New Dyllsynerl~ 8.4%(191) 6.0%(216) 1.7(0.7. 4 0) 
Conctualens: The value of exercise MPI and RNA results are dear, but 
available data are less promising for pharmacologic stress testing, empha- 
sizing the need for larger, well-controlled studies. 
4:15 
~ '~"1  Exercise Versus Oobutamlne Echocardlography In 
Patients With Chronic Coronary Artery D;~,~,~ 
Loukianos Rallid's, Philip Cokkinos, Ioannis Moysselds, Francis Marchall, 
Celia Oaldey, Patros Nihoyannopoulos. Department of ~ne,  Clinical 
Hammemm/th Hos~,  RPMS, London, U.K. 
To compare the extent of Ischasmla pred~tatad by digital exercise (EE) and 
debutamIne ~ (DE) in chronic stable coronmy artery disease 
(CAD), 39 ¢onsesutive pa~anfa (pts) able to esetclea unden~¢~ EE and DE 
on the asnle day. "rWenty-one p1'= had 1 vesasl disease (IVD), 10 2VD and 8 
3VD. Twenty-twe p~ mma tma~d wlth b-bicckem which were ~',~mineed 
in 11 before the tests. EE wes performed an a meddled Bruce pmtocdi 
DE with increasing doses of debufamine (5-40 ~ )  and the addi~n 
of atropine If th.J 85% of the ma~lrr~l predicted heart r=Je (HR) was not 
achieved, The tests were assesesd using the tofal Ischaemlc scare Mdex In 
an 11 se~ protocol, The walls were scored as: 1 = normoldnat~ 2 = 
hypoldnetlo, 3 - akMe~ and 4 -, dyskthebo. The table shows the maximal 
blood pressure (BP), maximal HR and heart rate blood pressure product 
(RPP) for both tests: 
BP (max) HR (max) RPP 
EE 169.6:1:30.2 140.S =b21.5 23661.6 :t: 6303.1 
DE 132.74-23.1 145.0:1:16.8 1~R41.6:1:4249.6 
p 0.0001 NS 0.0001 
Them was a greafar number of pasitive tsats with EE than with DE (69% 
vs 56%, p -  NS). The maximal tschaemic score Index was greater during EE 
than with DE (1.65 + 0.38 vs 1.44 -t- 0.4o p = 0.01) in the 22 pts with both 
tests positive. Thus, EE prec l~ a greater magnitude of tschaemla than 
DE in chronic CAD tots pod~ps due to the greater wofldead posed on the 
heart by the incressed BP. 


Are stress imaging modalities of value in post-myocardial infarction predischarge risk stratification? A meta-analysis of stress perfusion and ventricular function imaging studies 

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Are stress imaging modalities of value in post-myocardial infarction predischarge risk stratification? A meta-analysis of stress perfusion and ventricular function imaging studies

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