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Changes in regional myocardial function after coronary artery bypass graft surgery are predicted by intraoperative low-dose dobutamine echocardiography.

Publication ,  Journal Article
Aronson, S; Dupont, F; Savage, R; Drum, M; Gunnar, W; Jeevanandam, V
Published in: Anesthesiology
September 2000

BACKGROUND: Left ventricular dysfunction is often reversed after coronary artery bypass graft (CABG) surgery; however, this change is not easily predicted. The authors hypothesized that functional changes after a low dose of dobutamine (5 microgram. kg-1. min-1) intraoperatively would predict functional changes when complete revascularization was achieved. METHODS: The authors analyzed 560 segments in 40 patients scheduled for elective CABG surgery for regional wall motion (1-5 scoring system) at four stages: baseline (after induction and intubation), with administration of low-dose dobutamine before cardiopulmonary bypass, after separation from cardiopulmonary bypass (early), and after administration of protamine (late). Two independent observers scored the myocardial regions according to a 16-segment model in multiple imaging planes. For each segment, the response to dobutamine was dichotomized as improved or not improved from baseline and analyzed with logistic regression. The influence of covariates (ejection fraction, myocardial infarction, diabetes mellitus, and beta blockers) was also determined with logistic regression models. P < 0.05 was considered significant. RESULTS: Changes in myocardial function after low-dose dobutamine were highly predictive for early (P < 0.0001) and late (P < 0.0001) changes in myocardial function from baseline regional scores. The overall odds ratio for early and late improvement increased by 20.7 and 34.6, respectively, when improvement was observed after low-dose dobutamine was administered. The overall positive predictive value of improved regional wall motion after CABG did not vary with left ventricular ejection fraction, a history of myocardial infarction, or beta blocker use, and it varied little with diabetic status (range, 0.86-0.96) if regional wall motion improved with low-dose dobutamine before CABG. The overall negative predictive value was 0.70; however, the range varied with diabetic status (i.e., lowest in diabetic patients and highest in nondiabetic patients). CONCLUSION: Intraoperative low-dose dobutamine is a reliable method to predict myocardial functional reserve and to determine functional recovery expected after coronary revascularization.

Duke Scholars

Published In

Anesthesiology

DOI

ISSN

0003-3022

Publication Date

September 2000

Volume

93

Issue

3

Start / End Page

685 / 692

Location

United States

Related Subject Headings

  • Middle Aged
  • Male
  • Humans
  • Heart
  • Female
  • Echocardiography
  • Dobutamine
  • Cardiopulmonary Bypass
  • Anesthesiology
  • Aged, 80 and over
 

Citation

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Aronson, S., Dupont, F., Savage, R., Drum, M., Gunnar, W., & Jeevanandam, V. (2000). Changes in regional myocardial function after coronary artery bypass graft surgery are predicted by intraoperative low-dose dobutamine echocardiography. Anesthesiology, 93(3), 685–692. https://doi.org/10.1097/00000542-200009000-00017
Aronson, S., F. Dupont, R. Savage, M. Drum, W. Gunnar, and V. Jeevanandam. “Changes in regional myocardial function after coronary artery bypass graft surgery are predicted by intraoperative low-dose dobutamine echocardiography.Anesthesiology 93, no. 3 (September 2000): 685–92. https://doi.org/10.1097/00000542-200009000-00017.
Aronson S, Dupont F, Savage R, Drum M, Gunnar W, Jeevanandam V. Changes in regional myocardial function after coronary artery bypass graft surgery are predicted by intraoperative low-dose dobutamine echocardiography. Anesthesiology. 2000 Sep;93(3):685–92.
Aronson, S., et al. “Changes in regional myocardial function after coronary artery bypass graft surgery are predicted by intraoperative low-dose dobutamine echocardiography.Anesthesiology, vol. 93, no. 3, Sept. 2000, pp. 685–92. Pubmed, doi:10.1097/00000542-200009000-00017.
Aronson S, Dupont F, Savage R, Drum M, Gunnar W, Jeevanandam V. Changes in regional myocardial function after coronary artery bypass graft surgery are predicted by intraoperative low-dose dobutamine echocardiography. Anesthesiology. 2000 Sep;93(3):685–692.

Published In

Anesthesiology

DOI

ISSN

0003-3022

Publication Date

September 2000

Volume

93

Issue

3

Start / End Page

685 / 692

Location

United States

Related Subject Headings

  • Middle Aged
  • Male
  • Humans
  • Heart
  • Female
  • Echocardiography
  • Dobutamine
  • Cardiopulmonary Bypass
  • Anesthesiology
  • Aged, 80 and over