Dobutamine response and myocardial infarct transmurality: Functional improvement after coronary artery bypass grafting-initial experience
Dobutamine response and myocardial infarct transmurality: Functional improvement after coronary artery bypass grafting-initial experience
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DOI：
10.1148/radiol.2403051150
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发表时间：
2006-09-01
期刊：
影响因子：
19.7
通讯作者：
Kramer, Christopher M.
中科院分区：
文献类型：
--
作者：
Bove, Christina M.;DiMaria, Joseph M.;Kramer, Christopher M.
研究审查委员会批准了该方案，所有患者均签署了知情同意书。该方案符合HIPAA。本研究的目的是前瞻性地检验这一假设，即在1%-50%梗死透壁性（IT）的节段中加入低剂量多巴酚丁胺和定量变力储备可提高慢性梗死血运重建后功能恢复的预测值。15例多支冠状动脉疾病和左心室收缩功能不全的患者在冠状动脉旁路移植术（CABG）前入组。采用晚期钆增强心脏磁共振（MR）成像来评估IT。在静息和10 μ g（圈）kg（-1）/min多巴酚丁胺输注期间，采用电影心脏MR成像测量室壁增厚百分比。20周+/-4周（标准误差）后重复心脏MR成像。采用重复测量模型的F检验比较CABG前后各节段的功能参数。在1%-50%IT的节段中，1%-25%或26%-50%IT的节段的功能恢复相似。然而，在相同的节段中，多巴酚丁胺改善至正常范围的节段在血运重建后的壁增厚百分比（22% +/- 4）比未改善的节段（9% +/-4）有更大的改善（P <0.04）。在1%-50% IT中，正常的多巴酚丁胺反应有助于区分CABG后功能恢复更好的节段。
The Investigational Review Board approved the protocol, and all patients provided signed informed consent. The protocol was compliant with HIPAA. The purpose of the study was to prospectively test the hypothesis that addition of low-dose dobutamine and quantification of inotropic reserve in segments with 1%-50% infarct transmurality (IT) would improve the predictive value for functional recovery after revascularization in chronic infarction. Fifteen patients with multivessel coronary artery disease and left ventricular systolic dysfunction were enrolled prior to coronary artery bypass grafting (CABG). Late gadolinium-enhanced cardiac magnetic resonance (MR) imaging was used to assess IT. The percentage of wall thickening was measured with cine cardiac MR imaging at rest and during infusion of 10 (mu g (circle) kg(-1))/min dobutamine. Repeat cardiac MR imaging was performed 20 weeks +/- 4 (standard error) later. Functional parameters according to segment were compared before and after CABG by using F tests with repeated-measures models. In segments with 1%-50% IT, similar functional recovery was noted in those with 1%-25% or 26%-50% IT. However, in the same segments, those that improved with dobutamine to normal range demonstrated greater improvement in the percentage of wall thickening (22% +/- 4) after revascularization than those that did not (9% +/- 4) (P < .04). In 1%-50% IT, a normal dobutamine response helps differentiate segments with greater functional recovery after CABG.