Relation of contractile reserve during low-dose dobutamine echocardiography and angiographic extent and severity of coronary artery disease in the presence of left ventricular dysfunction

Contractile reserve, during low-dose dobutamine echocardiography, is frequently used for the assessment of myocardial viability in patients with coronary artery disease (CAD) and left ventricular (LV) dysfunction. Whether contractile reserve is affected by the severity of the underlying CAD is presently unknown. Accordingly, we studied 58 patients with stable CAD and LV dysfunction who underwent coronary angiography and low-dose dobutamine echocardiography. In each vascular region the worst stenosis was identified and quantitated as percent diameter stenosis. Segmental wall motion during echocardiography was scored visually and rest and dobutamine wall motion score indexes were calculated. Contractile reserve was defined as greater than or equal to 1 grade improvement in wall motion score of greater than or equal to 2 contiguous segments along with greater than or equal to 20% reduction in global wall motion scare index with dobutamine. There was no difference between patients with (n = 26) and without (n = 32) contractile reserve in percent coronary stenosis (89 +/- 17% vs 87 +/- 17%, p = 0.6), number of coronary arteries with > 50% diameter stenosis (2.0 +/- 0.8 vs 2.2 +/- 0.7, p = 0.4), number of occluded coronary arteries (1.2 +/- 0.9 vs 1.1 +/- 0.9, p = 0.6), or the prevalence of collaterals demonstrated angiographically (61% vs 56%, p = 0.5). Our data demonstrates that in patients with CAD and LV dysfunction, the prevalence of contractile reserve during low-dose dobutamine echocardiography is independent of the angiographic extent and severity of CAD. (C) 1997 by Excerpta Medico, Inc.