Viability Tested with Dobutamine Stress Echocardiography and Prognosis Early after Acute Myocardial Infarction: A Meta-Analysis: A Meta-Analysis

RB van Loon, Martijn W Heymans, G Veen, AC van Rossum

Research output: Contribution to journalReview articleAcademicpeer-review


In non-high risk patients treated without primary PCI for acute myocardial infarction (AMI), the updated American
Heart Association/American College of Cardiology guidelines recommend a selective pharmacoinvasive strategy
(IIb, level C). Early risk assessment is essential to select patients with an increased risk for ischemic events or
cardiac death. A potential prognostic value has been ascribed to viability in the infarct region. Viability-testing with
Low Dose Dobutamine echocardiography (LDDE) can safely be performed in the early phase after AMI. Since the
prognostic value of viability after acute myocardial infarction remains unclear and is still debated, we performed
a meta-analysis of post-infarction studies to elucidate the importance and prognostic value of viability early after
AMI. The literature was scanned by formal searches of electronic databases from 1966 to June 2010. We used
the following selection criteria for inclusion in this meta-analysis: a) viability testing with LDDE within 14 days after
Acute Myocardial Infarction (AMI), b) preserved left ventricular function (ejection fraction(EF) ≥40% or wall motion
score index (WMSI) ≤1.9), c) prognosis scored by clinical endpoints (death, AMI or unstable angina (UA)). Eight
observational studies were included in the meta-analysis (2301 patients). Results: The presence of viability was
strongly associated with an increase in ischemic cardiac events [OR 5.0 (1.53 - 16.36), p=0.008]. No predictive value
was found for mortality [OR 0.91 (0.38 - 2.18), p=0.84]. In conclusion, patients with preserved left ventricular function
and proven viability early after AMI are at risk for ischemic cardiac events, without any difference in mortality (Metaanalysis,
acute myocardial infarction, viability, echocardiography).
Original languageEnglish
Number of pages7
JournalJ Clin Exp Cardiolog
Issue numberS5
Publication statusPublished - 28 Apr 2012

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