Postextrasystolic potentiation echocardiography in predicting reversible myocardial dysfunction by surgical coronary revascularization

• Published in: The American journal of cardiology Vol. 81; no. 12; pp. 36G - 40G
• Main Authors: Scognamiglio, Roldano, Marin, Marco, Miorelli, Manuela, Palisi, Monica, Fasoli, Giuseppe, Dalla Volta, Sergio
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 18.06.1998; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Biological and medical sciences; Cardiovascular disease; Cardiovascular system; Coronary Disease - diagnostic imaging; Coronary Disease - surgery; Coronary vessels; Echocardiography, Doppler - methods; Female; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Medical screening; Middle Aged; Myocardial Revascularization; Patients; Predictive Value of Tests; Prognosis; Prospective Studies; Sensitivity and Specificity; Surgery; Ultrasonic investigative techniques; Ventricular Dysfunction - diagnostic imaging; Sonography; Human; Potentiation; Echocardiography; Arrhythmia; Cardiovascular disease; Exploration; Extrasystole; Coronary heart disease; Excitability disorder; Sensitivity; Specificity; Functional recovery; Treatment; Aortocoronary; Bypass; Heart disease; Surgery; Myocardium; Graft; Technique; Viability
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(98)00052-6

Sustained inotropic stimulation, such as dobutamine infusion, has the potential to cause an additional contractile deterioration in viable but chronically hypoperfused and dysfunctioning myocardium, by inducing ischemia. Postextrasystolic potentiation (PESP) represents a potent inotropic stimulus without risk of provoking ischemia, as it is instantaneous. In this study, we assessed the role of PESP-echocardiographic examination in predicting the recovery of regional contractility after coronary revascularization. We examined 105 consecutive patients with multivessel coronary artery disease who were candidates for bypass surgery; 79 were included in this prospective study. Preoperative reversibility of contractile dysfunction in asynergic myocardial regions was determined by PESP, with a coupling interval of 500 msec decreasing to 300 msec, with a progressive decrease by 10 msec. The examination was accompanied by continuous 2-dimensional (2D) echocardiographic monitoring. The assessed sensitivity and specificity were 92% and 87%, respectively; the predictive accuracy was 90%. These results demonstrated that PESP echocardiography is a useful and cost-effective method for identifying viable myocardium in patients undergoing myocardial revascularization.