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Articles in PresS, published online ahead of print November 8, 2001
Am J Physiol Heart Circ Physiol, 10.1152/ajpheart.00786.2001
Submitted on September 4, 2001
Accepted on November 2, 2001
1 Division of Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom; MRC Clinical Sciences Centre, National Heart and Lung Institute, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
2 MRC Clinical Sciences Centre, National Heart and Lung Institute, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
3 Division of Cardiology, National Heart and Lung Institute, Imperial College School of Medicine, Hammersmith Hospital, London, United Kingdom
* To whom correspondence should be addressed. E-mail: ebarnes{at}doctors.org.uk.
Nine patients with coronary artery disease (CAD) and normal left ventricular (LV) function underwent two episodes of dobutamine-induced ischemia to determine whether repeated episodes of ischemia lead to cumulative stunning. Positron emission tomography (PET) and H215O was used to assess myocardial blood flow (MBF) at baseline, peak stress and after stress for each ischemic episode. Quantitative echocardiographic assessment of global (EF) and regional systolic function (SF) was performed at rest and regular intervals after dobutamine. SF was assessed for regions subtended by a coronary artery with a >70% diameter stenosis. Both EF and SF were more severely impaired 45 minutes after the second episode of stress compared with 45 minutes after the first (both p<0.01), despite no difference in duration of the 2 dobutamine infusions or MBF at peak stress (1.72 vs 1.69). After both episodes of ischemia, when LV function was impaired, but subsequently recovered, MBF (1.15±0.39 and 1.20±0.43 respectively) was no different to baseline MBF (1.02±0.35) confirming that repeated episodes of dobutamine-induced ischemia lead to cumulative myocardial stunning.
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