Relationship Between the Abscence of Myocardial Viability Determined by Dobutamine-Echocardiography and the Deficit of Coronary Collateral Circulation

pp 753-759

Abstract

Background

Angiography is still the gold standard in the evaluation of patients with ischemic cardiomyopathy, even though most of the coronary layer is constituted by small vessels that cannot be evaluated by this technique. To our knowledge, there are only few studies that correlate the search of myocardial viability with dobutamine stress echocardiography (DSE) and the presence or absence of coronary collateral circulation in the angiographic study.

Objective

To analyze the distribution of collateral circulation in those dyssynergic segments at baseline evaluated with dobutamine stress echocardiography for the detection of myocardial viability.

Material and method

In a 12 patient population (11 male, 11 female; mean age 58 years) with ischemic-necrotic cardiomyopathy and severe left ventricular dysfunction (ejection fraction S 35%) DSE (low and high doses) was per-formed -consecutively and prospectively- for the detection of ischemia/viability. All of them under-went coronary angiography to asses the extent and severity of the coronary lesions, and the presence and amount of coronary collateral circulation (4 levels).

Results

The correlation between dyssynergic territories without evidence of viability and those with absent or insufficient coronary collateral circulation in the angiography was statistically significant (p = 0.002, Fisher's exact test). In the viable segments it was observed either presence (sufficient or insufficient) or absence of coronary collateral circulation.

Conclusion

In the analyzed population the absence of viability determined by DSE in dissynergic regions at baseline was able to predict that coronary collateral circulation in those territories was insufficient or absent.