[Dobutamine stress echocardiography in patients with acute myocardial infarct].

The objective of the present work was to evaluate dobutamine echocardiography in patients after myocardial infarction. The group of patients comprises 39 subjects, age 54 +/- 10 years with a first non-complicated myocardial infarction treated by thrombolysis. The patients were examined on the 5th-7th day with small amounts of dobutamine (5 and 10 micrograms/kg/min.) and a maximal test after two weeks and three months after the myocardial infarction. During the week after the first maximal test coronarography was made in 33 patients. During the first examination at rest the authors observed asynergy in 237 of 780 segments. Low dobutamine doses revealed the presence of a viable myocardium in 87 segments (36%). The sensitivity, specificity, positive predictive value and negative predictive value were 72%, 77%, 55% and 88%. In eleven patients several arteries were affected, the sensitivity of dobutamine echocardiography for prediction of affection of several vessels was 70% and the specificity 95%. During examinations after three months in some of the patients the kinetics improved, in particular in patients after revascularization operations and in patients who were subjected to a rehabilitation programme. The authors conclude that dobutamine echocardiography is a safe loading method with a minimum of side-effects even in patients in early stages of myocardial infarction. The use of low dobutamine doses is a new promising method for assessment of reversible but also irreversible myocardial dysfunction. The maximal test will help to detect patients with affections of several vessels and help to differentiate patients with a greater risk and necessity of more aggressive treatment.