Improved detection of inferobasal ischemia during dobutamine echocardiography with doppler tissue imaging.

OBJECTIVES: The purpose of this study was quantitative evaluation of the inferobasal segment during dobutamine stress echocardiography using Doppler tissue imaging (DTI). BACKGROUND: Overdiagnosis of myocardial ischemia during dobutamine echocardiography is a common problem. DTI may permit more accurate quantitative diagnosis of ischemia. METHODS: A total of 50 patients with normal contraction of the inferobasal segment at rest were referred for dobutamine stress echocardiography. All underwent coronary angiography. Systolic and diastolic myocardial velocities were measured from apical 2-chamber view at rest and at the peak of dobutamine infusion. RESULTS: Stenosis of the right coronary artery >or= 70% was detected in 11 patients. Conventional stress echocardiography was falsely positive in 10.3% and falsely negative in 27.3%. When DTI was combined with conventional stress echocardiography, sensitivity and specificity was 81.8% and 97.4%, respectively. CONCLUSION: DTI may enhance the diagnosis of inferior ischemia during dobutamine echocardiography and can be added to conventional imaging in the treatment of these patients.

Diverse presentations of cardiac rupture following acute myocardial infarction.

BACKGROUND: Cardiac rupture is a rare but ominous complication of myocardial infarction. OBJECTIVES: To study the clinical presentation, medical course, outcome and echocardiographic predictors of patients with myocardial rupture. METHODS: We evaluated 15 consecutive patients with cardiac rupture during a 4 year period in our department. The current report explores the presence of potential risk factors, timing, relation to the thrombolysis, coronary interventions and outcome. RESULTS: The index event in all patients was first ST elevation myocardial infarction. In seven patients rupture occurred in the first 24 hours. Pericardial effusion on admission with a clot was present in three patients. Five patients received thrombolytic therapy. Only three patients underwent coronary angioplasty, but in one case it was performed late and in two patients the culprit artery could not be opened. Six patients reached the operating room, of whom three survived. CONCLUSIONS: The lack of early mechanical reperfusion in acute myocardial infarction and thrombolytic therapy are risk factors for cardiac rupture. Pericardial effusion on admission and evidence of a clot are echocardiographic indicators of cardiac rupture and should alert the medical team to further assess the possibility of cardiac rupture.