Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography.

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  • معلومة اضافية
    • Abstract:
      Background: Although dobutamine-atropine stress echocardiography (DASE) has been widely used for evaluating patients with coronary artery disease (CAD), dynamic changes that occur at microcirculatory level during each stage of stress have not been demonstrated in humans. Aim: We sought to determine variations in myocardial blood flow (MBF) during DASE using quantitative real time myocardial contrast echocardiography (RTMCE). Methods: We studied 45 patients who underwent coronary angiography and RTMCE. Replenishment velocity of microbubbles in the myocardium (β) and MBF reserves were obtained at baseline, intermediate stage (70% of maximal predicted heart rate), peak stress, and recovery phase. Results: β and MBF reserves were lower in patients with than without CAD at intermediate (1.65 vs. 2.10; P = 0.001 and 2.44 vs. 3.23; P = 0.004) and peak (1.63 vs. 3.00; P < 0.001 and 2.14 vs. 3.98; P < 0.001, respectively). In patients without CAD, β, and MBF reserves increased from intermediate to peak and decreased at recovery, while in those without CAD reserves did not change significantly. Optimal cutoff values of β reserve at intermediate, peak, and recovery were 1.78, 2.09, and 1.70, with areas under the curves of 0.80 (95%CI = 0.67-0.94), 0.89 (95%CI = 0.79-0.99), and 0.69 (95%CI = 0.53-0.85). Sensitivity, specificity and accuracy for detecting CAD at intermediate stage were 68% (95%CI = 48-89), 85% (95%CI = 71-98), and 78% (95%CI = 66-90), at peak stress were 79% (95%CI = 61-97), 96% (95%CI = 89-100), and 89% (95%CI = 80-98), and at recovery were 74% (95%CI = 54-93), 65% (95%CI = 47-84), and 69% (95%CI = 55-82), respectively. Conclusion: RTMCE allows for quantification of dynamic changes in microcirculatory blood flow at each stage of DASE. The best parameter for detecting CAD in all stages was β reserve. (Echocardiography 2011;28:993-1001) [ABSTRACT FROM AUTHOR]
    • Abstract:
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    • Author Affiliations:
      1Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
      2University of São Paulo Medical School, São Paulo, Brazil
      3Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, São Paulo, Brazil
    • ISSN:
      0742-2822
    • Accession Number:
      10.1111/j.1540-8175.2011.01473.x
    • Accession Number:
      66283091
  • Citations
    • ABNT:
      MATHIAS JR, W. et al. Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography. Echocardiography, [s. l.], v. 28, n. 9, p. 993–1001, 2011. DOI 10.1111/j.1540-8175.2011.01473.x. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=66283091&custid=s8280428. Acesso em: 20 fev. 2020.
    • AMA:
      Mathias Jr W, Kowatsch I, Saroute AN, et al. Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography. Echocardiography. 2011;28(9):993-1001. doi:10.1111/j.1540-8175.2011.01473.x.
    • APA:
      Mathias Jr, W., Kowatsch, I., Saroute, A. N., Osório, A. F. F., Sbano, J. C. N., Dourado, P. M. M., Ramires, J. A. F., & Tsutsui, J. M. (2011). Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography. Echocardiography, 28(9), 993–1001. https://doi.org/10.1111/j.1540-8175.2011.01473.x
    • Chicago/Turabian: Author-Date:
      Mathias Jr, Wilson, Ingrid Kowatsch, Ally Nader Saroute, Altamiro Filho Ferraz Osório, João César Nunes Sbano, Paulo Magno Martins Dourado, José Antonio Franchini Ramires, and Jeane Mike Tsutsui. 2011. “Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography.” Echocardiography 28 (9): 993–1001. doi:10.1111/j.1540-8175.2011.01473.x.
    • Harvard:
      Mathias Jr, W. et al. (2011) ‘Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography’, Echocardiography, 28(9), pp. 993–1001. doi: 10.1111/j.1540-8175.2011.01473.x.
    • Harvard: Australian:
      Mathias Jr, W, Kowatsch, I, Saroute, AN, Osório, AFF, Sbano, JCN, Dourado, PMM, Ramires, JAF & Tsutsui, JM 2011, ‘Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography’, Echocardiography, vol. 28, no. 9, pp. 993–1001, viewed 20 February 2020, .
    • MLA:
      Mathias Jr, Wilson, et al. “Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography.” Echocardiography, vol. 28, no. 9, Oct. 2011, pp. 993–1001. EBSCOhost, doi:10.1111/j.1540-8175.2011.01473.x.
    • Chicago/Turabian: Humanities:
      Mathias Jr, Wilson, Ingrid Kowatsch, Ally Nader Saroute, Altamiro Filho Ferraz Osório, João César Nunes Sbano, Paulo Magno Martins Dourado, José Antonio Franchini Ramires, and Jeane Mike Tsutsui. “Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography.” Echocardiography 28, no. 9 (October 2011): 993–1001. doi:10.1111/j.1540-8175.2011.01473.x.
    • Vancouver/ICMJE:
      Mathias Jr W, Kowatsch I, Saroute AN, Osório AFF, Sbano JCN, Dourado PMM, et al. Dynamic Changes in Microcirculatory Blood Flow during Dobutamine Stress Assessed by Quantitative Myocardial Contrast Echocardiography. Echocardiography [Internet]. 2011 Oct [cited 2020 Feb 20];28(9):993–1001. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=asn&AN=66283091&custid=s8280428