Enoximone echocardiography for predicting recovery of left ventricular dysfunction after revascularization : A novel test for detecting myocardial viability

• Published in: Circulation (New York, N.Y.) Vol. 101; no. 11; pp. 1255 - 1260
• Main Authors: CHUNZENG LU, CARLINO, M, FRAGASSO, G, MAISANO, F, MARGONATO, A, CAPPELLETTI, A, CHIERCHIA, S. L
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 21.03.2000; American Heart Association, Inc
• Subjects: Adult; Aged; Biological and medical sciences; Cardiology. Vascular system; Cardiotonic Agents; Coronary heart disease; Dobutamine; Echocardiography; Enoximone; Heart; Heart - physiopathology; Humans; Male; Medical sciences; Middle Aged; Myocardial Contraction; Myocardial Revascularization; Predictive Value of Tests; Prognosis; Recovery of Function; Sensitivity and Specificity; Tissue Survival; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - surgery; Ventricular Function, Left; Sonography; Human; Pharmacologic test; Cardiotonic agent; Echocardiography; Prognosis; Cardiovascular disease; Coronary heart disease; Left ventricle; Chronic; Dysfunction; Enoximone; Myocardium; Viability
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.101.11.1255

The possibility that enoximone, a nonglycoside, noncatechol, positive inotropic agent, in combination with 2-dimensional echocardiography may predict recovery of myocardial dysfunction after revascularization has not been yet evaluated. Forty-five patients with chronic coronary artery disease and left ventricular dysfunction underwent dobutamine (DE, 5 to 10 microg. kg(-1). min(-1)) and enoximone (EE, 1.5 mg/kg, over 10 minutes) echocardiography. Myocardial wall motion was scored from 1 (normal) to 4 (dyskinesia): an asynergic segment was considered to have contractile enhancement when the score decreased by >/=1 grade. Of 478 asynergic segments, 216 (45%) exhibited functional recovery after revascularization. Dobutamine- and enoximone-induced contractile enhancement was observed in 41% and 46% of segments, respectively. Compared with DE, EE had higher sensitivity (88% versus 79%, P<0.01) and negative predictive value (90% versus 84%, P<0.05) in predicting functional recovery. The specificity (89% versus 90%) and positive predictive value (87% for both EE and DE) were similar. Concordant interpretation of EE and DE findings was found in 85% (406 of 478) of affected segments. Prerevascularization coronary angiography showed that stenosis severity of vessels supplying areas which only improved with enoximone was significantly greater (89.9%) than that of vessels (77.7%) supplying areas that responded to both agents (P<0.02). Both dobutamine and enoximone increased heart rate (16% and 10%, respectively), whereas enoximone did not cause changes in systolic blood pressure that increased by 14% with dobutamine. Enoximone echocardiography provides a novel and reliable approach for the prediction of functional recovery after revascularization. Compared with dobutamine echocardiography, the test yields higher sensitivity and induces lesser hemodynamic alterations.