DOBUTAMINE STRESS ECHOCARDIOGRAPHY BEFORE AND AFTER CORONARY ANGIOPLASTY

Myocardial function was assessed by stress echocardiography in 28 patients before and after successful elective coronary angioplasty. Dobutamine stress echocardiography was performed using up to 40-mu-g/kg/min, followed by the addition of atropine in 20 patients to achieve 85% of the predicted maximal exercise heart rate. The initial studies were performed 1 day before and the second ones within 3 days (mean 1.3) after angioplasty. Peak heart rates and systolic blood pressures were the same for the 2 studies. The frequency of dobutamine-induced new wall motion abnormalities decreased from 20 (71%) before to 4 (14%) after angioplasty (p < 0.0001). Before angioplasty, wall motion score index (an indicator of left ventricular wall motion, an increase in which indicates impaired wall motion due to myocardial ischemia) increased from 1.06 at rest to 1.23 at peak stress (p < 10(-6)), but there was no significant increase in this index in the study after angioplasty. Before angioplasty, 14 patients (50%) developed chest pain during the stress test compared with 6 (21%) after angioplasty (p = 0.05), and before angioplasty, the stress test was stopped before the target heart rate was achieved, because of symptoms, ST-segment change or severe new wall motion abnormality in 14 patients compared with 7 after angioplasty (p = 0.09). Thus, early after angioplasty there is a reduction in myocardial ischemia as assessed by dobutamine stress echocardiography.