Journal of Cardiothoracic Surgery (Feb 2025)
Low-dose dobutamine stress myocardial contrast echocardiography for evaluating myocardial microcirculation perfusion and predicting long-term prognosis in ST-segment elevation myocardial infarction after percutaneous coronary intervention
Abstract
Abstract Objective Percutaneous coronary intervention (PCI) can effectively restore myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI). Nevertheless, STEMI patients may still experience a “no-reflow” phenomenon after PCI. Accordingly, this study focused on the clinical value of low-dose dobutamine stress myocardial contrast echocardiography (MCE) for evaluating myocardial microcirculation perfusion and long-term prognosis in STEMI patients after PCI. Methods This study included 70 STEMI patients receiving PCI. Low-dose dobutamine stress MCE was performed to detect viable myocardium at 72 h after PCI and quantitatively analyze myocardial microcirculation perfusion at 72 h and 6 months after PCI. Patients were categorized into dobutamine stress echocardiography (DSE)-positive and DSE-negative groups, followed by comparisons of LVEF. The 3-year survival of STEMI patients after PCI was analyzed. Results No adverse reactions occurred during low-dose dobutamine stress MCE. Low-dose dobutamine stress MCE effectively detected viable myocardium at 72 h after PCI (AUC: of 0.849). Under the basal or stress state, A, β, and A × β values of viable myocardium at 6 months after PCI were prominently higher than values at 72 h after PCI. A and A × β values of viable myocardium at 6 months after PCI were considerably higher in the stress state than in the basal state. LVEF and long-term survival rates after PCI were markedly higher in the DSE-positive group than in the DSE-negative group. Conclusion Low-dose dobutamine stress MCE is an effective evaluation method for myocardial perfusion, left ventricular function recovery, and poor long-term prognosis in STEMI patients after PCI.
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