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급성심근경색증후 좌심실의 Remodeling에 대한 예측도구로써 Dobutamine 심초음파의 역할

Other Titles
 Dobutamine Echocardiography in the Prediction of Left Ventricular Remodeling after Acute Myocardial Infarction 
 정남식  ;  이남호  ;  고충원  ;  하종원  ;  김지영  ;  오은경  ;  안신기  ;  김태용 
 Journal of the Korean Society of Echocardiography (한국심초음파학회지), Vol.5(2) : 85-93, 1997 
Journal Title
Journal of the Korean Society of Echocardiography(한국심초음파학회지)
Issue Date
Background : Left ventricular remodeling after acute myocardial infarction has been
identified as an important prognostic factor because it leads to ventricular enlargement,
ventricular aneurysm, and increased mortality. However predictors of left ventricular
remodeling are not clearly defined. This study was performed to evaluate the efficacy of
dobutamine echocardiography in the prediction of left ventricular remodeling in patients
with acute myocardial infarction.
Methods : Forty-five patients(39 males, age 56.9±10.2 years) with acute myocardial
infarction(AMI) and patent infarct-related artery(no significant narrowing with/without
revascularization) underwent dobutamine echocardiography at 2-7 days after AMI. The
stages of dobutamine infusion were baseline, 5, 10, 20ug/kg/min, and images at each
stage were directly compared and analyzed with the use of 16-segment model(by
American Society of Echocardiography) and scoring system(1 : normal, 2 : mild to
moderate hypokinesia, 3 : severe hypokinesia, 4 akinesia, 5 : dyskinesia). The viability of
infarct zone was defined as improvement of wall motion score in more than 2
contiguous segments during dobutamine infusion in areas of resting asynergy. Coronary
angiography was performed at 7-10 days after AMI and revascularization of
infarct-related artery was done, if severe stenosis was present. Follow-up(F/U)
echocardiography was performed more than 3 months after AMI. We have measured left
ventricular end-diastolic and end-systolic volume at baseline, dobutamine(peak dose) and
follow-up echocardiography by modified Simpson's method.
Results :
1) Dobutamine echocardiography was performed at 5.5±3.9 days after acute
myocardial infarction, and follow-up echocardiography was performed at 7.5±3.4
months after dobutamine echocardiography.
2) We assessed left ventricular end-diastolic volume(LVEDV) at follow-up
echocardiography compared to LVEDV at baseline echocardiography, and patients were
divided into 2 groups : Group 1(n=14) with increase in LVEDV during F/U period(mean
change 13.9±14.2ml) ; Group 2(n=31) with no increase in LVEDV volume during F/U
period(mean change -27.4±22.1). Between two groups, clinical parameters such as age,
sex, incidence of anterior myocardial infarction, incidence of non-Q myocardial infarction,
peak CK, peak CKMB, pre-infarction angina, incidence of reperfusion therapy, follow-up
duration, were not significantly different.
3) Between group 1 and group 2, there were no significant differences in baseline
echocardiographic parameters such as ejection fraction, wall motion score index, LVEDV,
LV end-diastolic dimension.
4) In group 1, the incidence of patients with infarct zone viability assessed by
dobutamine echocardiography was significantly smaller than the one in group 2(5 of 14
and 21 of 31, respectively, p<0.05).
5) Between group 1 and group 2, the change of LVEDV at dobutamine
echocardiography compared to LVEDV at baseline echocardiography was significantly
different(-1.3±17.7 and -17.1±26.2, respectively, p<0.05).
6) Linear regression analysis indicated that the change of LVEDV during follow-up
period was predicted by the change of LVEDV during dobutamine echocardiography.
LVEDV(F/U)-LVEDV(baseline)=0.726[LVEDV(dobutamine) - LVEDV(baseline)]
-5.648(r=0.65, p<0.05).
Conclusion : The viability of infarct zone assessed by dobutamine echocardiography
was predictive of left ventricular remodeling at F/U of acute myocardial infarction and
the change in LVEDV during dobutamine echocardiography correlated with the change
in LVEDV at follow up of acute myocardial infarction. Dobutamine echocardiography can
be an useful tool for the prediction of LV remodeling artier acute myocardial infarction.
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Shim, Won Heum(심원흠)
Ahn, Shin Ki(안신기) ORCID logo https://orcid.org/0000-0002-9822-7961
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Rim, Se Joong(임세중) ORCID logo https://orcid.org/0000-0002-7631-5581
Jang, Yang Soo(장양수) ORCID logo https://orcid.org/0000-0002-2169-3112
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
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