좌심실 기능부전을 동반한 만성 관상동맥질환에서 Dobutamine 심초음파의 역할

Abstract

Background : Dobutamine echocardiography has been shown to be a valuable tool for determining myocardial viability in both acute and chronic coronary artery disease with left ventricular dysfunction. The purpose of the our study was to identify the role of dobutamine echocardiography in the prediction of improvement of regional left ventricular (LV) dysfunction after revascularization of chronic coronary artery disease. Methods : Twenty-three patients (mean age 61.29.0 years ; 20 men) with chronic LV dysfunction underwent dobutamine echocardiography (dobutamine : baseline, 5, 10, 20 jig/Kg/min) before coronary revascularization (coronary artery bypass graft surgery 16, percutaneous coronary angioplasty 7). The mean LV ejection fraction was 42.98.8% with ranging from 26% to 58%. Follow-up echocardiography was performed at 2 to 21 months (mean 9.06.2 months) after revascularization. Results : During dobutamine echocardiography, there was no major complication. Improvement of the dysfunctional myocardium was observed in 12 of 23 patients in dobutamine echocardiography. Among them, 10 patients showed functonal recovery after revascularization. Another 11 patients did not show improvement of dysfunctional myocardium in dobutamine echocardiography, however 3 of them showed functional recovery after revascularization. One hundred fifteen dysfunctional segments were found in 368 segments of 23 patients, and improvement of wall motion abnormality was observed in 46 of 115 segments in dobutamine echocardiography. Among them, 31 segments showed functional recovery after revascularization. Another 69 segments did not show wall motion improvement in dobutamine echocardiography. But among them, 13 segments showed functional recovery after revascularization. The sensitivity and specificity of dobutamine echocardiography for the prediction of postoperative improvement of segmental wall motion were 70% and 79%, respectively. The positive and negative predictive value of dobutamine echocardiography were 679/6 and 81%, respectively. Conclusion : In patients with chronic LV dysfunction, dobutamine echocardiography can be used as a predictor of the improvement of dysfunctional segments after revascularization.