Dobutamine Stress Echocardiography in the Evaluation of Hibernating Myocardium

8/9/2019 Dobutamine Stress Echocardiography in the Evaluation of Hibernating Myocardium

1/10

Dobutamine stress echocardiography in the evaluation of hibernating myocardiumAuthor Wilson S Colucci, MDSection Editor Warren J Manning, MDDeputy Editor Brian C Downey, MD, FACCDisclosures: Wilson S Colucci, MD Consultant/Advisory Boards: Merck [eart !ailure "#nala$ril%&' (ovartis [eart!ailure "#nala$ril%&' Janssen [eart !ailure&' Mast [eart !ailure&) #*uity +wnersi$/Stock +$tions: Cardio-yl [eart!ailure&) Warren J Manning, MD.rant/esearc/Clinical 0rial Su$$ort: 1ili$s Medical Syste2s [Cardiac M"32aging e*ui$2ent%&) #*uity +wnersi$/Stock +$tions: 1!i4er "1ar2aceuticals%) #*uity +wnersi$/Stock +$tions"S$ouse%: .eneral #lectric "32aging e*ui$2ent%) Brian C Doney, MD, !ACC#2$loyee o! 5$0oDate, 3nc)

Contri6utor disclosures are reviewed !or con!licts o! interest 6y te editorial grou$) Wen !ound, tese are addressed6y vetting troug a 2ulti7level review $rocess, and troug re*uire2ents !or re!erences to 6e $rovided to su$$ort tecontent) A$$ro$riately re!erenced content is re*uired o! all autors and 2ust con!or2 to 5$0oDate standards o!evidence)

Conflict of interest policy

All to$ics are u$dated as new evidence 6eco2es availa6le and our $eer review $rocess isco2$lete)"iterature revie current through# Fe6 89;) < $his topic last updated# Jun 9=, 89>)

%&$'(D)C$%(& ? 32$aired le!t ventricular "@% systolic !unction in $atients wit coronary eart

disease is o!ten a $artially reversi6le $rocess "ta6le %) As an e-a2$le, le!t ventricular !unction 2ay

i2$rove 2arkedly, and even nor2ali4e, in su6sets o! $atients !ollowing success!ul revasculari4ation

"!igure % [7&)

Since 2any studies ave esta6lised a relation 6etween @ systolic !unction and cardiovascular

$rognosis, it is reasona6le to s$eculate tat i2$roved @ systolic !unction !ollowing

revasculari4ation would 6e associated wit a !avora6le e!!ect on outco2e) 0e su$eriority o!

revasculari4ation co2$ared to 2edical 2anage2ent in selected $atients wit coronary disease and

@ dys!unction is co2$ati6le wit tis y$otesis [>,;&) 0e 2yocardiu2 tat recovers !unction a!ter

revasculari4ation as 6een called i6ernating) 0o te e-tent tat i2$rove2ent in regional or glo6al

@ systolic !unction is a signi!icant goal in suc $atients, te a6ility to accurately assess regional

2yocardial via6ility in a dys!unctional territory $rior to revasculari4ation 6eco2es an i2$ortant

co2$onent o! te decision 2aking $rocess "ta6le 8 and algorit2 and algorit2 8%)

"See Diagnosis and 2anage2ent o! isce2ic cardio2yo$aty, section on

evasculari4ation and Clinical syndro2es o! stunned or i6ernating 2yocardiu2)%

Do6uta2ine stress ecocardiogra$y as e2erged as an i2$ortant noninvasive clinical tool !or te

detection o! i6ernating 2yocardiu2 [=,E&) 0e role o! do6uta2ine stress ecocardiogra$y in te

evaluation o! 2yocardial via6ility in te setting o! i6ernation will 6e reviewed ere) 0e use o! oter

2odalities in conunction wit do6uta2ine stress, suc as Do$$ler studies, te relative e!!icacy o!oter i2aging 2odalities "eg, radionuclide i2aging, 2agnetic resonance i2aging% !or te detection

o! i6ernating 2yocardiu2, and $rotocols !or do6uta2ine stress ecocardiogra$y are discussed

se$arately) "See #valuation o! i6ernating 2yocardiu2 and +verview o! stress

ecocardiogra$y, section on Do6uta2ine stress ecocardiogra$y)%

D(B)$AM%&E S$'ESS EC*(CA'D%(+'A*- ? 1ar2acologic stress ecocardiogra$y

e-a2ines te inotro$ic reserve o! dys!unctional 6ut via6le 2yocardiu2 at rest 6y te

http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributorshttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributorshttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributorshttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributorshttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributorshttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributorshttp://www.uptodate.com/home/conflict-interest-policyhttp://www.uptodate.com/home/editorial-policyhttp://www.uptodate.com/home/editorial-policyhttp://www.uptodate.com/contents/image?imageKey=CARD%2F52865&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/image?imageKey=CARD%2F55621&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/1-3http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/4,5http://www.uptodate.com/contents/image?imageKey=CARD%2F63612&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/image?imageKey=CARD%2F70975&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/image?imageKey=CARD%2F70975&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/image?imageKey=CARD%2F67744&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/diagnosis-and-management-of-ischemic-cardiomyopathy?source=see_link&anchor=H12#H12http://www.uptodate.com/contents/diagnosis-and-management-of-ischemic-cardiomyopathy?source=see_link&anchor=H12#H12http://www.uptodate.com/contents/clinical-syndromes-of-stunned-or-hibernating-myocardium?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/6,7http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_linkhttp://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_linkhttp://www.uptodate.com/contents/overview-of-stress-echocardiography?source=see_link&anchor=H7#H7http://www.uptodate.com/contents/overview-of-stress-echocardiography?source=see_link&anchor=H7#H7http://www.uptodate.com/contents/overview-of-stress-echocardiography?source=see_link&anchor=H7#H7http://www.uptodate.com/contents/overview-of-stress-echocardiography?source=see_link&anchor=H7#H7http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributorshttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributorshttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributorshttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributorshttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributorshttp://www.uptodate.com/home/conflict-interest-policyhttp://www.uptodate.com/home/editorial-policyhttp://www.uptodate.com/contents/image?imageKey=CARD%2F52865&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/image?imageKey=CARD%2F55621&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/1-3http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/4,5http://www.uptodate.com/contents/image?imageKey=CARD%2F63612&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/image?imageKey=CARD%2F70975&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/image?imageKey=CARD%2F67744&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/diagnosis-and-management-of-ischemic-cardiomyopathy?source=see_link&anchor=H12#H12http://www.uptodate.com/contents/diagnosis-and-management-of-ischemic-cardiomyopathy?source=see_link&anchor=H12#H12http://www.uptodate.com/contents/clinical-syndromes-of-stunned-or-hibernating-myocardium?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/6,7http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_linkhttp://www.uptodate.com/contents/overview-of-stress-echocardiography?source=see_link&anchor=H7#H7http://www.uptodate.com/contents/overview-of-stress-echocardiography?source=see_link&anchor=H7#H7http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/contributors


2/10

ad2inistration o! an inotro$ic agent, wit do6uta2ine6eing te 2ost !re*uently used agent) ia6le

2yocardiu2 sows i2$roved glo6al or regional contractile !unction "inotro$ic reserve%, as assessed

6y si2ultaneous transtoracic ecocardiogra$y, in res$onse to inotro$e ad2inistration [G&) 0e

$revalence o! contractile reserve in $atients wit CD and @ dys!unction is inde$endent o! te

angiogra$ic e-tent and severity o! coronary artery disease, and te i2$rove2ent in contractility in

y$o$er!used via6le 2yocardiu2 does not re*uire an increase in regional 2yocardial $er!usion[H,9&)

A contractile res$onse to do6uta2ine a$$ears to re*uire tat at least ;9 $ercent o! te 2yocytes in

a given seg2ent are via6le' te contractile res$onse also correlates inversely wit te e-tent o!

interstitial !i6rosis on 2yocardial 6io$sy [&) 3n co2$arison, radionuclide 2yocardial $er!usion

i2aging identi!ies seg2ents wit !ewer via6le 2yocytes) 3n one series, !or e-a2$le, do6uta2ine

stress ecocardiogra$y and talliu2 i2aging sowed e*uivalent sensitivity a2ong seg2ents wit

2ore tan E; $ercent via6le 2yocytes "EG versus GE $ercent% 6ut do6uta2ine stress

ecocardiogra$y was 2uc less sensitive a2ong seg2ents wit 8; to ;9 $ercent via6le 2yocytes

"; versus G8 $ercent% [8&)

0e $redictive value o! do6uta2ine stress ecocardiogra$y a$$ears to 6e greatest wen tere is a6i$asic res$onse: i2$rove2ent at low dose and worsening at ig7dose do6uta2ine [,>&) 0e

initial i2$rove2ent in wall 2otion re!lects recruit2ent o! contractile reserve during low7dose

do6uta2ine, and ence re!lects via6ility [;&) 3n co2$arison, iger doses lead to su6endocardial

isce2ia and worsening o! te wall 2otion a6nor2ality, identi!ying stress7induced isce2ia) 0us,

testing at various doses a$$ears to 6e i2$ortant !or te o$ti2al assess2ent o! 2yocardial

i6ernation 6y tis tecni*ue)

0e concurrent use o! 6eta 6lockers at te ti2e o! te do6uta2ine stress ecocardiogra2 can a!!ect

te res$onse to do6uta2ine and reduce te nu26er o! via6le seg2ents detected [=&) 3! a study

during 6eta 6locker tera$y sows only li2ited via6ility, it 2ay 6e use!ul to re$eat te test a!ter te

dose as 6een reduced) "See +verview o! stress ecocardiogra$y, section on Do6uta2inestress ecocardiogra$y)%

%mprovement in ". function after CAB+ ? Do6uta2ine stress ecocardiogra$y can 6e used to

identi!y i6ernating 2yocardiu2 $rior to coronary artery 6y$ass gra!t "CAB.% surgery) Several

studies ave sown tat it can 6e used to $redict te likeliood o! recovery a!ter CAB. [,E,G&:

IA2ong G $atients wit coronary disease and @ systolic dys!unction wo underwent two7

di2ensional ecocardiogra$y at rest and during do6uta2ine in!usion, = $ercent o!

dys!unctional seg2ents wit inotro$ic reserve sowed i2$roved regional systolic !unction a!ter

CAB. [E&) 0e $ositive and negative $redictive accuracy o! do6uta2ine in!usion !or

$redicting !unctional i2$rove2ent o! dys!unctional seg2ents a!ter CAB. was H and G8

$ercent, res$ectively)IA2ong = $atients wo underwent serial do6uta2ine stress ecocardiogra$y and

radionuclide ventriculogra$y $rior to CAB., a 6i$asic res$onse "i2$rove2ent at low dose

and worsening at ig dose do6uta2ine% was igly $redictive o! recovery, es$ecially in

seg2ents wit te 2ost severe wall 2otion a6nor2alities at 6aseline [&) +ter $atterns o!

do6uta2ine res$onsiveness were $redictors o! non7recovery "!igure 8%)

I3n a series o! $atients, tose wit te largest a2ount o! dys!unctional 6ut via6le

2yocardiu2, de!ined as = seg2ents i2$roving wit low7dose do6uta2ine, ad te greatest

http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/8http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/8http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/9,10http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/9,10http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/11http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/11http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/12http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/12http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13,14http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13,14http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/16http://www.uptodate.com/contents/overview-of-stress-echocardiography?source=see_link&anchor=H7#H7http://www.uptodate.com/contents/overview-of-stress-echocardiography?source=see_link&anchor=H7#H7http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13,17,18http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/17http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13http://www.uptodate.com/contents/image?imageKey=CARD%2F61817&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/8http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/9,10http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/11http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/12http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13,14http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/16http://www.uptodate.com/contents/overview-of-stress-echocardiography?source=see_link&anchor=H7#H7http://www.uptodate.com/contents/overview-of-stress-echocardiography?source=see_link&anchor=H7#H7http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13,17,18http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/17http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13http://www.uptodate.com/contents/image?imageKey=CARD%2F61817&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_link


3/10

!unctional i2$rove2ent in le!t ventricular eection !raction a!ter surgical revasculari4ation and a

lower rate o! cardiac events during a 89 2ont !ollow7u$ [G&)

Wile a 6i$asic res$onse to do6uta2ine is $redictive o! 2ecanical recovery a!ter CAB., te

a2ount o! dys!unctional 6ut via6le 2yocardiu2 2ay 6e a 6etter $redictor o! long ter2 outco2e)

0is was suggested 6y a study o! H; $atients in wo2 2ulti$le indices o! via6ility were 2easured

6y do6uta2ine stress ecocardiogra$y $rior to CAB. [H&) A!ter a !ive year !ollow u$, te a2ount

o! dys!unctional 6ut via6le 2yocardiu2, as assessed 6y wall 2otion score during low dose

do6uta2ine, was te 2ost i2$ortant inde$endent $redictor o! survival "a4ard ratio [& =)E, H;K

C3 8)G to ;)G%) A 6i$asic res$onse to do6uta2ine, wile signi!icant on 2ultivaria6le analysis, was

less i2$ortant)

0e $redictive value o! do6uta2ine stress ecocardiogra$y is si2ilar to tat o! $ositron e2ission

to2ogra$y "1#0% scanning "!igure % [89&) 0e accuracy is less, owever, wen tere is a totally

occluded coronary artery [8&) "See#valuation o! i6ernating 2yocardiu2, section on #!!icacy o!

i2aging tests)%

%mprovement in ". systolic function after percutaneous revasculari/ation ? 0e accuracy

o! do6uta2ine stress ecocardiogra$y !or $redicting recovery o! @ !unction a!ter $ercutaneous

revasculari4ation in $atients wit sta6le coronary disease and @ dys!unction as also 6een

evaluated)

I3n a study o! 89 $atients undergoing do6uta2ine stress ecocardiogra$y, te accurate

$rediction o! recovera6ility o! contractile !unction de$ended u$on te ty$e o! wall 2otion

res$onse o6served during do6uta2ine [>&)0e greatest i2$rove2ent in @ systolic !unction

was seen in $atients wit a 6i$asic res$onse to do6uta2ine, wit less i2$rove2ent in

$atients wit eiter no cange or sustained i2$rove2ent a!ter do6uta2ine)

I0e ad2inistration o! nitroglycerin 2ay i2$rove te accuracy o! do6uta2ine stress

ecocardiogra$y in detecting via6le 2yocardiu2) 3n an ani2al 2odel, nitroglycerin enanced

te i2$rove2ent wit low dose do6uta2ine 6ut did not $revent ig dose do6uta2ine !ro2

inducing isce2ia in i6ernating 2yocardiu2 [88&) 0e clinical e!!icacy o! nitroglycerin7

do6uta2ine ecocardiogra$y was evaluated in a study o! 8 $atients in wo2 9H o! ;8

2yocardial seg2ents were akinetic or dyskinetic [8&) 3n ter2s o! i2$roved contractility a!ter

revasculari4ation, nitroglycerin7do6uta2ine ecocardiogra$y ad a lower sensitivity tan rest7

redistri6ution talliu2 and 2yocardial contrast ecocardiogra$y "= versus H; and GE

$ercent, res$ectively%, 6ut was te 2ost s$eci!ic "G versus E and >G $ercent%) (itroglycerin

alone increased regional tickening in 89 $ercent o! via6le akinetic seg2ents, suggesting tat

it 2ay 6e a use!ul addition to do6uta2ine sti2ulation)

%mprovement in survival after revasculari/ation ? 1atients wit le!t ventricular systolic

dys!unction wo de2onstrate 2yocardial via6ility wit do6uta2ine stress ecocardiogra$y ave a6etter outco2e wit revasculari4ation tan wit 2edical tera$y [;,8>,8;&)

I3n a study o! G $atients wit coronary eart disease and a le!t ventricular eection !raction

L; $ercent, tose wit 2yocardial via6ility "as deter2ined 6y do6uta2ine stress

ecocardiogra$y% ad a lower 2ortality at G 2onts wen treated wit coronary artery

6y$ass gra!t "CAB.% surgery co2$ared to tose wit via6ility wo were treated 2edically or

tose witout via6ility wo underwent CAB. "= versus 89 and E $ercent, res$ectively% [8>&)

http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/18http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/19http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/image?imageKey=CARD%2F79730&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/20http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/21http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H3#H3http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H3#H3http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/14http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/14http://www.uptodate.com/contents/nitroglycerin-glyceryl-trinitrate-drug-information?source=see_linkhttp://www.uptodate.com/contents/nitroglycerin-glyceryl-trinitrate-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/22http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/22http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/23http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/23http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15,24,25http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/24http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/18http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/19http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/image?imageKey=CARD%2F79730&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/20http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/21http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H3#H3http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H3#H3http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/14http://www.uptodate.com/contents/nitroglycerin-glyceryl-trinitrate-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/22http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/23http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15,24,25http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/24


4/10

I0e results o! do6uta2ine stress ecocardiogra$y can also $redict long7ter2 outco2e

[;,8;&) 3n a study o! GE $atients wit eart !ailure due to an isce2ic cardio2yo$aty wo

were !ollowed !or >9 2onts, cardiac 2ortality in $atients wit at least ; "out o! 8% seg2ents

sowing 2yocardial via6ility wo underwent CAB. was $ercent, wit associated

i2$rove2ent in !unctional class and le!t ventricular eection !raction [8;&) 3n contrast, cardiac

2ortality was , ;9, and >> $ercent in tose wit 2yocardial via6ility in at least ; seg2entswo were treated 2edically and in tose wit less tan ; seg2ents sowing 2yocardial

via6ility wo underwent revasculari4ation or 2edical tera$y, res$ectively)

Si2ilar 2ortality 6ene!its ave 6een re$orted wit all o! te 2aor i2aging tecni*ues !or te

detection o! 2yocardial via6ility) 3n a 2eta7analysis o! 8> via6ility studies "wit via6ility deter2ined

6y do6uta2ine ecocardiogra$y, talliu2 $er!usion i2aging, or $ositron e2ission to2ogra$y

"1#0% scanning% involving 9GG $atients wit coronary artery disease and le!t ventricular

dys!unction, 2yocardial via6ility was $resent in >8 $ercent [8=&) 0e $atients wit 2yocardial

via6ility ad an G9 $ercent reduction in annual 2ortality wit revasculari4ation ")8 versus =

$ercent wit 2edical tera$y%) 3n contrast, tere was no di!!erence in annual 2ortality wit

revasculari4ation in $atients witout 2yocardial via6ility "annual 2ortality E)E versus =)8 $ercent

wit 2edical tera$y%)

A si2ilar di!!erence in 2ortality was noted in anoter review in wic annual 2ortality was reduced

a!ter revasculari4ation only in $atients wit 2yocardial via6ility "E versus 89 $ercent wit 2edical

tera$y% [8E&) "SeeDiagnosis and 2anage2ent o! isce2ic cardio2yo$aty, section on

evasculari4ation)%

)se after M% ? Do6uta2ine stress ecocardiogra$y is also use!ul !or esta6lising te $resence o!

i6ernating 2yocardiu2 due to a residual stenosis !ollowing a 2yocardial in!arction "M3%) 3n one

series o! 88 $atients undergoing a do6uta2ine7atro$ine stress ecocardiogra$y witin one week

a!ter M3, te $resence o! eiter an isce2ic or a 6i$asic res$onse in two or 2ore contiguous

in!arction 4ones was 6ot sensitive "G8 $ercent% and s$eci!ic "G9 $ercent% !or a residual stenosisand ad a $redictive accuracy o! G8 $ercent [8G&) Sensitivity was greatest wen a 6i$asic res$onse

was o6served) 3n anoter study sustained i2$rove2ent wit ig dose do6uta2ine was te 2ost

s$eci!ic $redictor "99 $ercent% !or te a6sence o! signi!icant residual stenosis [8H&)

Do6uta2ine stress ecocardiogra$y is also o! use !or $redicting recovery and te e-tent o!

irreversi6ly da2aged 2yocardiu2 a!ter direct angio$lasty in $atients wit an acute M3 [9&) 3ts

$redictive value !or i2$rove2ent is iger !or y$okinetic tan akinetic seg2ents) ecovery o! rest

regional @ contraction usually occurs *uickly a!ter revasculari4ation, altoug one7*uarter o!

$atients re*uire u$ to si- weeks [&) 1atients wo recover rest !unction a!ter angio$lasty sow te

2ost 2arked i2$rove2ent wit do6uta2ine' owever, so2e i2$rove2ent 2ay 6e seen in tose

witout recovery o! rest !unction, $articularly wen tere was evidence o! isce2ia 6e!ore

revasculari4ation)

Altoug do6uta2ine stress ecocardiogra$y is use!ul !or $redicting recovery, dys!unctional 6ut

via6le seg2ents 2ay sow less i2$rove2ent in 6asal contractility a!ter revasculari4ation tan

$redicted) As an e-a2$le, one study $er!or2ed do6uta2ine stress ecocardiogra$y 2ore tan

tree 2onts a!ter CAB. [8&) Most in!arct 4ones wic sowed contractile reserve 6e!ore surgery

6ut wic !ailed to recover a!ter surgery ad te sa2e or greater contractile reserve wit

http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15,25http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/25http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/25http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/26http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/27http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/27http://www.uptodate.com/contents/diagnosis-and-management-of-ischemic-cardiomyopathy?source=see_link&anchor=H12#H12http://www.uptodate.com/contents/diagnosis-and-management-of-ischemic-cardiomyopathy?source=see_link&anchor=H12#H12http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/28http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/28http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/29http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/29http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/30http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/31http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/31http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/32http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15,25http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/25http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/26http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/27http://www.uptodate.com/contents/diagnosis-and-management-of-ischemic-cardiomyopathy?source=see_link&anchor=H12#H12http://www.uptodate.com/contents/diagnosis-and-management-of-ischemic-cardiomyopathy?source=see_link&anchor=H12#H12http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/28http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/29http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/30http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/31http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/32


5/10

do6uta2ine' so2e contractile reserve was $resent even in tose in!arct 4ones tat sowed no

reserve $reo$eratively [8&)

)se in ". dysfunction after M% ? Do6uta2ine stress ecocardiogra$y a!ter a 2yocardial

in!arction "M3% can identi!y residual, isce2ic via6le 2yocardiu2 wic can act as a su6strate !or

!urter events)

I3n one study o! G $atients wit le!t ventricular "@% dys!unction !ollowing M3, te $resence

o! 2yocardial via6ility was te only inde$endent $redictor o! recurrent isce2ic events "89

versus E $ercent witout via6le 2yocardiu2% [&) owever, via6ility in te a6sence o!

underlying isce2ia 2ay 6e $rotective in $atients wit glo6al @ dys!unction a!ter M3 in wo2

te recovery o! @ !unction can o!!set te risk o! isce2ia)

I3n anoter study evaluating > $atients wit 2oderate to severe resting @ dys!unction a!ter

an M3, te $resence and e-tent o! via6ility was associated wit a lower 2ortality at H 2onts

")H versus ;); $ercent !or no via6ility% [>&) 3n $atients wit a greater nu26er o! seg2ents

sowing i2$rove2ent, tere was a larger i2$act o! via6ility on survival) 3n contrast, te

$resence o! induci6le isce2ia was te 6est $redictor o! cardiac deat)

)se in the elderly ? Do6uta2ine stress ecocardiogra$y can 6e used sa!ely in elderly $atients to

evaluate cest $ain) 3n ;;9 octogenarians evaluated !or cest $ain, DS# was sa!e, $redicted te

risk o! cardiac events over te su6se*uent two years, and identi!ied a su6set at ig risk o! a

cardiac event [;&)

Comparison ith perfusion imaging ? Direct co2$arisons 6etween nuclear i2aging tecni*ues

and do6uta2inestress ecocardiogra$y are li2ited) owever, wen used !or te assess2ent o!

2yocardial via6ility and i6ernating 2yocardiu2, do6uta2ine stress ecocardiogra$y as 6ot a

ig negative $redictive value as well as a ig $ositive $redictive value "!igure >%) "See #valuation

o! i6ernating 2yocardiu2, section on 1ooled analysis o! rM13 and D# studies)%

Comparison ith CM' ? @ate gadoliniu2 enance2ent cardiovascular 2agnetic resonancei2aging "CM% can accurately discri2inate nonvia6le !ro2 via6le 2yocardial seg2ents) owever,

te accuracy o! low7dose do6uta2ineCM and low7dose do6uta2ine ecocardiogra$y is not

known as tey ave not 6een directly co2$ared) owever, in a co2$arative study using ig7dose

do6uta2ine stress ecocardiogra$y and do6uta2ine CM, CM ad a iger sensitivity and

s$eci!icity !or detection o! via6le seg2ents) 0is was $ri2arily related to nonvisuali4ation o!

seg2ents on sur!ace ecocardiogra$y) Co2$arison o! late gadoliniu2 enance2ent CM versus

low dose do6uta2ine stress CM suggests tat low dose do6uta2ine CM is su$erior, $ri2arily

related to i2$roved accuracy !or $atients wit inter2ediate late gadoliniu2 enance2ent $attern)

"See Clinical utility o! cardiovascular 2agnetic resonance i2aging, section on Myocardial

via6ility)%

'ole in idiopathic dilated cardiomyopathy ? Do6uta2ine stress ecocardiogra$y is use!ul !or

esta6lising te $rognosis o! $atients wit an idio$atic dilated cardio2yo$aty, as an i2$rove2ent

in le!t ventricular contractility "eection !raction or wall 2otion score% $redicts a lower incidence o!

cardiac deat or need !or trans$lantation [=,E&)

3n one o! te largest $ros$ective studies, do6uta2ine stress ecocardiogra$y was $er!or2ed using

ig7dose do6uta2ine "u$ to >9 g/kg $er 2in% in G> $atients wit a le!t ventricular eection

!raction less tan 9 $ercent [=&) A!ter a ; 2ont !ollow7u$, $atients wit a large inotro$ic

http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/32http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/32http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/33http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/33http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/34http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/34http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/35http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/35http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/image?imageKey=CARD%2F50864&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H13#H13http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H13#H13http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H13#H13http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/clinical-utility-of-cardiovascular-magnetic-resonance-imaging?source=see_link&anchor=H36992887#H36992887http://www.uptodate.com/contents/clinical-utility-of-cardiovascular-magnetic-resonance-imaging?source=see_link&anchor=H36992887#H36992887http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/36,37http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/36http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/36http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/32http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/33http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/34http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/35http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/image?imageKey=CARD%2F50864&topicKey=CARD%2F1528&rank=5~148&source=see_link&search=uso+de+dobutaminahttp://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H13#H13http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H13#H13http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/clinical-utility-of-cardiovascular-magnetic-resonance-imaging?source=see_link&anchor=H36992887#H36992887http://www.uptodate.com/contents/clinical-utility-of-cardiovascular-magnetic-resonance-imaging?source=see_link&anchor=H36992887#H36992887http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/36,37http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/36


6/10

res$onse to do6uta2ine "de!ined as a cange in wall 2otion score inde- 9)>>% ad a signi!icantly

6etter survival "H> versus =H $ercent !or a s2all or no res$onse to do6uta2ine%) A large cange in

wall 2otion score inde- was an inde$endent $redictor o! outco2e on 2ultivariate analysis)

"See1redictors o! survival in eart !ailure due to systolic dys!unction)%

E&(0%M(&E S$'ESS EC*(CA'D%(+'A*- ? Do6uta2ine stress ecocardiogra$y is widely

used to assess 2yocardial via6ility, 6ut te inotro$ic res$onse to adrenergic sti2ulation 2ay 6e

attenuated in $atients receiving a 6eta 6locker) 3n addition, do6uta2ine 2ay so2eti2es induce

isce2ia in $atients wit a critical coronary stenosis, wic 2igt 2ask i6ernation 6y $reventing

te i2$rove2ent in wall 2otion)

An alternative a$$roac is te use o! a $os$odiesterase ini6itor suc as eno-i2one

or 2ilrinone, drugs wic ave 6een used !or inotro$ic su$$ort in te treat2ent o! eart !ailure)

0ese drugs are relatively una!!ected 6y concurrent use o! a 6eta 6locker) "See +verview o! te

tera$y o! eart !ailure due to systolic dys!unction)%

0e $ossi6le role o! eno-i2one stress ecocardiogra$y was evaluated in one study o! >; $atients

wit cronic coronary artery disease and le!t ventricular dys!unction wo underwent

ecocardiogra$y wit 6ot do6uta2ine and eno-i2one [G&) Bot increased eart rate, 6ut

eno-i2one did not cause a cange in systolic 6lood $ressure) Concordant results were seen in G;

$ercent o! a!!ected seg2ents, 6ut eno-i2one ad a iger sensitivity "GG versus EH $ercent !or

do6uta2ine% and negative $redictive value "H9 versus G> $ercent% in $redicting !unctional recovery

a!ter revasculari4ation) S$eci!icity and $ositive $redictive value were si2ilar 6etween eno-i2one

and do6uta2ine)

Wile eno-i2one is not a$$roved !or use in te 5nited States, te $ar2acology o! 2ilrinone is

very si2ilar, and tis agent could 6e considered !or use as a $ar2acologic stress agent in selected

$atients on 6eta 6lockers) .iven te li2ited data, owever, we !eel tat !urter investigations are

re*uired to validate tis a$$roac)

%&!('MA$%(& !(' A$%E&$S ? 5$0oDate o!!ers two ty$es o! $atient education 2aterials, 0e

Basics and Beyond te Basics) 0e Basics $atient education $ieces are written in $lain language,

at te ;t to =t grade reading level, and tey answer te !our or !ive key *uestions a $atient 2igt

ave a6out a given condition) 0ese articles are 6est !or $atients wo want a general overview and

wo $re!er sort, easy7to7read 2aterials) Beyond te Basics $atient education $ieces are longer,

2ore so$isticated, and 2ore detailed) 0ese articles are written at te 9t to 8t grade reading

level and are 6est !or $atients wo want in7de$t in!or2ation and are co2!orta6le wit so2e

2edical argon)

ere are te $atient education articles tat are relevant to tis to$ic) We encourage you to $rint or

e72ail tese to$ics to your $atients) "Nou can also locate $atient education articles on a variety o!

su6ects 6y searcing on $atient in!o and te keyword"s% o! interest)%

IBasics to$ics "see 1atient in!or2ation: #cocardiogra2 "0e Basics%%

S)MMA'-

IDo6uta2ine stress ecocardiogra$y is an i2$ortant noninvasive clinical tool !or te

detection o! via6le i6ernating 2yocardiu2, or 2yocardiu2 tat recovers systolic !unction

a!ter revasculari4ation) ia6le 2yocardiu2 sows i2$roved glo6al "eection !raction% or

http://www.uptodate.com/contents/predictors-of-survival-in-heart-failure-due-to-systolic-dysfunction?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/milrinone-drug-information?source=see_linkhttp://www.uptodate.com/contents/milrinone-drug-information?source=see_linkhttp://www.uptodate.com/contents/overview-of-the-therapy-of-heart-failure-due-to-systolic-dysfunction?source=see_linkhttp://www.uptodate.com/contents/overview-of-the-therapy-of-heart-failure-due-to-systolic-dysfunction?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/38http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/38http://www.uptodate.com/contents/milrinone-drug-information?source=see_linkhttp://www.uptodate.com/contents/echocardiogram-the-basics?source=see_linkhttp://www.uptodate.com/contents/echocardiogram-the-basics?source=see_linkhttp://www.uptodate.com/contents/echocardiogram-the-basics?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/predictors-of-survival-in-heart-failure-due-to-systolic-dysfunction?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/milrinone-drug-information?source=see_linkhttp://www.uptodate.com/contents/overview-of-the-therapy-of-heart-failure-due-to-systolic-dysfunction?source=see_linkhttp://www.uptodate.com/contents/overview-of-the-therapy-of-heart-failure-due-to-systolic-dysfunction?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/38http://www.uptodate.com/contents/milrinone-drug-information?source=see_linkhttp://www.uptodate.com/contents/echocardiogram-the-basics?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_link


7/10

regional contractile !unction "inotro$ic reserve% in res$onse to inotro$e ad2inistration)

"See Do6uta2ine stress ecocardiogra$y a6ove)%

IWen $er!or2ed on $atients wit isce2ic eart disease and le!t ventricular

dys!unction, do6uta2ine stress ecocardiogra$y $redicts te likeliood o! le!t ventricular

!unctional recovery !ollowing 6ot surgical and $ercutaneous revasculari4ation) 3n addition, in

$atients wit le!t ventricular dys!unction $ost72yocardial in!arction wo ave not undergonerevasculari4ation, do6uta2ine stress ecocardiogra$y is use!ul !or esta6lising te $resence

o! i6ernating 2yocardiu2 due to a residual stenosis) "See 32$rove2ent in @ !unction a!ter

CAB.a6ove and 32$rove2ent in @ systolic !unction a!ter $ercutaneous

revasculari4ation a6ove and 5se a!ter M3a6ove)%

I1atients wit le!t ventricular dys!unction wo de2onstrate 2yocardial via6ility

wit do6uta2ine stress ecocardiogra$y ave a 6etter survival wit revasculari4ation tan

wit 2edical tera$y) "See 32$rove2ent in survival a!ter revasculari4ation a6ove)%

IDirect co2$arisons 6etween radionuclide i2aging and cardiovascular 2agnetic resonance

i2aging tecni*ues anddo6uta2ine stress ecocardiogra$y in te sa2e $atients are li2ited)

"See Co2$arison wit $er!usion i2aginga6ove and #valuation o! i6ernating 2yocardiu2,

section on 1ooled analysis o! rM13 and D# studies)%

5se o! 5$0oDate is su6ect to te Su6scri$tion and @icense Agree2ent)

'E!E'E&CES

) ees ., Bristow JD, Ore2kau #@, et al) 3n!luence o! aortocoronary 6y$ass surgery on le!tventricular $er!or2ance) ( #ngl J Med HE' 8G>:=)

8) Catteree O, Swan J, 1ar2ley WW, et al) 3n!luence o! direct 2yocardial revasculari4ationon le!t ventricular asynergy and !unction in $atients wit coronary eart disease) Wit and witout$revious 2yocardial in!arction) Circulation HE' >E:8E=)

) Brundage B, Massie BM, Botvinick #) 32$roved regional ventricular !unction a!tersuccess!ul surgical revasculari4ation) J A2 Coll Cardiol HG>' :H98)

>) Alder2an #@, Fiser @D, @itwin 1, et al) esults o! coronary artery surgery in $atients wit$oor le!t ventricular !unction "CASS%) Circulation HG' =G:EG;)

;) 1igott JD, Ooucoukos (0, +6er2an A, Cutter .) @ate results o! surgical and 2edicaltera$y !or $atients wit coronary artery disease and de$ressed le!t ventricular !unction) J A2 CollCardiol HG;' ;:9=)

=) Beck2ann S, Scartl M, Bocksc W, Fleck #) Diagnosis o! coronary artery disease andvia6le 2yocardiu2 6y stress ecocardiogra$y) Diagnostic accuracy o! di!!erent stress 2odalities)#ur eart J HH;' = Su$$l J:9)

E) Ceiri! J, Murgo J1) Assess2ent o! 2yocardial via6ility 6y do6uta2ine ecocardiogra$y)Coron Artery Dis HH;' =:=99)

G) occi ., 1older2ans D, Ba- JJ, et al) 5se!ulness o! te eection !raction res$onse todo6uta2ine in!usion in $redicting !unctional recovery a!ter coronary artery 6y$ass gra!ting in$atients wit le!t ventricular dys!unction) A2 J Cardiol 8999' G;:>>9)

http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H2http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H2http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H3http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H3http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H3http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H4http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H4http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H6http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H5http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H8http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H13#H13http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H13#H13http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H13#H13http://www.uptodate.com/contents/licensehttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/1http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/1http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/2http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/2http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/2http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/3http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/3http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/4http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/4http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/5http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/5http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/5http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/6http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/6http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/6http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/7http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/7http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/8http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/8http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/8http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H2http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H3http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H3http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H4http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H4http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H6http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H5http://www.uptodate.com/contents/dobutamine-drug-information?source=see_linkhttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium?source=machineLearning&search=uso+de+dobutamina&selectedTitle=5~148&sectionRank=1&anchor=H2#H8http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H13#H13http://www.uptodate.com/contents/evaluation-of-hibernating-myocardium?source=see_link&anchor=H13#H13http://www.uptodate.com/contents/licensehttp://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/1http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/1http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/2http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/2http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/2http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/3http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/3http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/4http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/4http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/5http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/5http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/5http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/6http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/6http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/6http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/7http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/7http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/8http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/8http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/8


8/10

H) Main M@, .ray6urn 1A, @andau C, A!ridi 3) elation o! contractile reserve during low7dosedo6uta2ine ecocardiogra$y and angiogra$ic e-tent and severity o! coronary artery disease inte $resence o! le!t ventricular dys!unction) A2 J Cardiol HHE' EH:9H)

9) BarillP F, De incentis ., Mangieri #, et al) ecovery o! contractility o! via6le 2yocardiu2during inotro$ic sti2ulation is not de$endent on an increase o! 2yocardial 6lood !low in te a6sence

o! collateral !illing) J A2 Coll Cardiol HHH' :=HE)

) (ague SF, Mikati 3, Weil6aecer D, et al) elation o! te contractile reserve o! i6ernating2yocardiu2 to 2yocardial structure in u2ans) Circulation HHH' 99:>H9)

8) Bau2gartner , 1orenta ., @au NO, et al) Assess2ent o! 2yocardial via6ility 6ydo6uta2ine ecocardiogra$y, $ositron e2ission to2ogra$y and talliu2789 S1#C0: correlationwit isto$atology in e-$lanted earts) J A2 Coll Cardiol HHG' 8:E9)

) Cornel J, Ba- JJ, #lendy A, et al) Bi$asic res$onse to do6uta2ine $redictsi2$rove2ent o! glo6al le!t ventricular !unction a!ter surgical revasculari4ation in $atients wit sta6lecoronary artery disease: i2$lications o! ti2e course o! recovery on diagnostic accuracy) J A2 CollCardiol HHG' :998)

>) A!ridi 3, Olei2an (S, ai4ner A#, Qog6i WA) Do6uta2ine ecocardiogra$y in 2yocardiali6ernation) +$ti2al dose and accuracy in $redicting recovery o! ventricular !unction a!ter coronaryangio$lasty) Circulation HH;' H:==)

;) Sawada S., @ewis SJ, Folt4 J, et al) 5se!ulness o! rest and low7dose do6uta2ine wall2otion scores in $redicting survival and 6ene!it !ro2 revasculari4ation in $atients wit isce2iccardio2yo$aty) A2 J Cardiol 8998' GH:G)

=) 1older2ans, D, So44i, FB, Ba-, JJ, et al) 3n!luence o! continuation o! 6eta 6lockers duringdo6uta2ine stress ecocardiogra$y !or te assess2ent o! 2yocardial via6ility in $atients witsevere isce2ic le!t ventricular dys!unction) A2 J Cardiol 899' GG:AE, =G)

E) 1errone7Filardi 1, 1ace @, 1rastaro M, et al) Do6uta2ine ecocardiogra$y $redictsi2$rove2ent o! y$o$er!used dys!unctional 2yocardiu2 a!ter revasculari4ation in $atients witcoronary artery disease) Circulation HH;' H:8;;=)

G) Melu4Rn J, Cern J, FrTlic M, et al) 1rognostic value o! te a2ount o! dys!unctional 6utvia6le 2yocardiu2 in revasculari4ed $atients wit coronary artery disease and le!t ventriculardys!unction) 3nvestigators o! tis Multicenter Study) J A2 Coll Cardiol HHG' 8:H8)

H) Sawada S, Ba$at A, a4 D, et al) 3ncre2ental value o! 2yocardial via6ility !or $rediction o!long7ter2 $rognosis in surgically revasculari4ed $atients wit le!t ventricular dys!unction) J A2 CollCardiol 899' >8:89HH)

89) Baer FM, ot #, Deutsc J, et al) 1redictive value o! low dose do6uta2inetranseso$ageal ecocardiogra$y and !luorine7G !luorodeo-yglucose $ositron e2issionto2ogra$y !or recovery o! regional le!t ventricular !unction a!ter success!ul revasculari4ation) J A2Coll Cardiol HH=' 8G:=9)

8) 1iscione F, 1errone7Filardi 1, De @uca ., et al) @ow dose do6uta2ine ecocardiogra$y !or $redicting !unctional recovery a!ter coronary revascularisation) eart 899' G=:=EH)

http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/9http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/9http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/9http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/10http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/10http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/10http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/11http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/11http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/12http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/12http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/12http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/14http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/14http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/14http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/16http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/16http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/16http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/17http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/17http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/17http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/18http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/18http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/18http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/19http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/19http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/19http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/20http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/20http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/20http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/20http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/21http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/21http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/9http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/9http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/9http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/10http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/10http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/10http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/11http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/11http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/12http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/12http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/12http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/13http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/14http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/14http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/14http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/15http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/16http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/16http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/16http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/17http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/17http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/17http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/18http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/18http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/18http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/19http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/19http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/19http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/20http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/20http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/20http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/21http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/21


9/10

88) Ma @, Cen @, .illa2 @, et al) (itroglycerin enances te a6ility o! do6uta2ine stressecocardiogra$y to detect i6ernating 2yocardiu2) Circulation HHE' H=:HH8)

8) @ing @, Cristian 0F, Mulvag S@, et al) Deter2ining 2yocardial via6ility in cronicisce2ic le!t ventricular dys!unction: a $ros$ective co2$arison o! rest7redistri6ution talliu2 89single7$oton e2ission co2$uted to2ogra$y, nitroglycerin7do6uta2ine ecocardiogra$y, and

intracoronary 2yocardial contrast ecocardiogra$y) A2 eart J 899=' ;:GG8)

8>) A!ridi 3, .ray6urn 1A, 1an4a JA, et al) Myocardial via6ility during do6uta2ineecocardiogra$y $redicts survival in $atients wit coronary artery disease and severe le!tventricular systolic dys!unction) J A2 Coll Cardiol HHG' 8:H8)

8;) Senior , Oaul S, @airi A) Myocardial via6ility on ecocardiogra$y $redicts long7ter2survival a!ter revasculari4ation in $atients wit isce2ic congestive eart !ailure) J A2 Coll CardiolHHH' :G>G)

8=) All2an OC, Saw @J, aca2ovitc , 5delson J#) Myocardial via6ility testing and i2$acto! revasculari4ation on $rognosis in $atients wit coronary artery disease and le!t ventriculardys!unction: a 2eta7analysis) J A2 Coll Cardiol 8998' H:;)

8E) 5nderwood S, Ba- JJ, vo2 Dal J, et al) 32aging tecni*ues !or te assess2ent o!2yocardial i6ernation) e$ort o! a Study .rou$ o! te #uro$ean Society o! Cardiology) #ur eart J899>' 8;:G;)

8G) S2art SC, Onickel6ine 0, Stoi6er 0, et al) Sa!ety and accuracy o! do6uta2ine7atro$inestress ecocardiogra$y !or te detection o! residual stenosis o! te in!arct7related artery and2ultivessel disease during te !irst week a!ter acute 2yocardial in!arction) Circulation HHE'H;:H>)

8H) Bigi , Cortigiani @, Desideri A, et al) Clinical and angiogra$ic correlates o! do6uta2ine7induced wall 2otion $atterns a!ter 2yocardial in!arction) A2 J Cardiol 899' GG:H>>)

9) @eclerc* F, Messner71ellenc 1, Moragues C, et al) Myocardial via6ility assessed 6ydo6uta2ine ecocardiogra$y in acute 2yocardial in!arction a!ter success!ul $ri2ary coronaryangio$lasty) A2 J Cardiol HHE' G9:=)

) A!ridi 3, Uuresi 5, Oo$elen A, et al) Serial canges in res$onse o! i6ernating2yocardiu2 to inotro$ic sti2ulation a!ter revasculari4ation: a do6uta2ine ecocardiogra$ic study)J A2 Coll Cardiol HHE' 9:8)

8) @o26ardo A, @o$er!ido F, 0rani C, et al) Contractile reserve o! dys!unctional 2yocardiu2a!ter revasculari4ation: a do6uta2ine stress ecocardiogra$y study) J A2 Coll Cardiol HHE'9:=)

) (iland F, Oa2$ +, erorst 1M, et al) 3n7os$ital and long7ter2 $rognostic value o! via6le2yocardiu2 detected 6y do6uta2ine ecocardiogra$y early a!ter acute 2yocardial in!arction andits relation to indicators o! le!t ventricular systolic dys!unction) A2 J Cardiol 899' GG:H>H)

>) 1icano #, Sicari , @andi 1, et al) 1rognostic value o! 2yocardial via6ility in 2edicallytreated $atients wit glo6al le!t ventricular dys!unction early a!ter an acute unco2$licated2yocardial in!arction: a do6uta2ine stress ecocardiogra$ic study) Circulation HHG' HG:9EG)

http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/22http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/22http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/23http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/23http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/23http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/23http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/24http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/24http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/24http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/25http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/25http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/25http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/26http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/26http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/26http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/27http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/27http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/27http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/28http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/28http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/28http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/28http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/29http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/29http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/30http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/30http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/30http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/31http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/31http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/31http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/32http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/32http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/32http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/33http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/33http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/33http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/34http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/34http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/34http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/22http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/22http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/23http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/23http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/23http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/24http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/24http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/24http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/25http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/25http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/25http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/26http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/26http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/26http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/27http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/27http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/27http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/28http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/28http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/28http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/29http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/29http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/30http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/30http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/30http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/31http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/31http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/31http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/32http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/32http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/32http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/33http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/33http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/33http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/34http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/34http://www.uptodate.com/contents/dobutamine-stress-echocardiography-in-the-evaluation-of-hibernating-myocardium/abstract/34


10/10

;) +Driscoll JM, Marciniak A, ay OO, et al) 0e sa!ety and clinical use!ulness o! do6uta2inestress ecocardiogra$y a2ong octogenarians) eart 89>' 99:99)

=) 1ratali @, 1icano #, +tasevic 1, et al) 1rognostic signi!icance o! te do6uta2ineecocardiogra$y test in idio$atic dilated cardio2yo$aty) A2 J Cardiol 899' GG:E>)

E) a2ai 0M, @ongo MD, Cadariu A, et al) Do6uta2ine7induced aug2entation o! le!tventricular eection !raction $redicts survival o! eart !ailure $atients wit severe non7iscae2iccardio2yo$aty) #ur eart J 89

Documents

Dobutamine Stress Echocardiography in the Evaluation of Hibernating Myocardium