(Circulation. 1995;91:2748-2752.)
© 1995 American Heart Association, Inc.
Articles |
Prediction of Improvement of Regional Left Ventricular Function After Surgical Revascularization
A Comparison of Low-Dose Dobutamine Echocardiography With 201Tl Single-Photon Emission Computed Tomography
From the Thoraxcenter, Departments of Cardiology (M.A., J.H.C., A.S., A.E., F.J.T.C., D.K., A.H.M.M.B., J.R.T.C.R., P.M.F.) and Cardiac Surgery (A.P.W.M.M.) and the Department of Nuclear Medicine (A.E.M.R.), University Hospital Rotterdam-Dijkzigt and Erasmus University, Rotterdam, Netherlands.
Background Although both 201Tl scintigraphy and low-dose dobutamine echocardiography (LDDE) have been proposed as effective methods of assessing myocardial viability, their relative efficacies are unknown. The aim of the present study was to compare the two imaging techniques in the prediction of improvement of regional left ventricular (LV) function after surgical revascularization.
Methods and Results Thirty-eight patients with severe chronic LV
dysfunction (ejection fraction 
40%, one or more akinetic [Ak] or
severely hypokinetic [SH] segments on resting echocardiogram) who
underwent uncomplicated coronary artery bypass graft surgery were
studied with simultaneous dobutamine stress echocardiography and
poststress reinjection 201Tl single-photon emission
computed tomography (SPECT) before surgery. The Ak or SH segments were
considered viable by LDDE when wall thickening improved during the
infusion of 10
µg · kg-1 · min-1
dobutamine. Scintigraphic definition of viability was the presence of
normal 201Tl uptake, totally reversible defect, partially
reversible defect, or moderately severe fixed defect. The postoperative
improvement of dyssynergic segments was determined with a rest
echocardiogram 3 months after surgery. Of 608 LV segments, 169 were
classified as Ak and 51 as SH on resting preoperative echocardiography.
Of these, 170 were successfully revascularized. Wall motion during LDDE
improved in 33 severely dyssynergic segments and was more frequent in
SH than in Ak segments (19 of 44 versus 14 of 126,
P<.0001). Viability was detected by 201Tl SPECT
criteria in 103 SH or Ak segments. Thirty-two of the 33 segments from
LDDE responders were judged viable on 201Tl SPECT, whereas
201Tl viability was also detected in 71 of 137 segments
from LDDE nonresponders. The sensitivity and the specificity for the
prediction of postoperative improvement of segmental wall motion were
74% (95% confidence interval [CI], 67% to 81%) and 95% (95% CI,
92% to 98%) by LDDE and 89% (95% CI, 84% to 94%) and 48% (95%
40% to 56%) by 201Tl SPECT, respectively. Positive
predictive value of LDDE was higher than that of 201Tl
SPECT (85%, [95% CI, 80% to 90%] versus 33% [95% CI, 26% to
40%]). Thirty-six patients had angina before and only 1 had angina 3
months after revascularization. High-dose dobutamine echocardiography
demonstrated significant reduction in stress-induced ischemia (new or
worsening of preexisting wall motion abnormalities) after surgery (from
163 to 23 LV segments).
Conclusions In patients with severe chronic LV dysfunction, LDDE is a good predictor of the improvement of dyssynergic segments after revascularization. Because 201Tl SPECT overestimates the probability of postoperative improvement of dyssynergic segments, LDDE should be the preferred imaging technique for preoperative assessment of these patients.
Key Words: dobutamine • myocardium • bypass • echocardiography • scintigraphy
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S. H. Rahimtoola Hibernating Myocardium Has Reduced Blood Flow at Rest That Increases With Low-Dose Dobutamine Circulation, December 15, 1996; 94(12): 3055 - 3061. [Full Text]
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R. O. Bonow Identification of Viable Myocardium Circulation, December 1, 1996; 94(11): 2674 - 2680. [Full Text]
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G. A. Beller Comparison of 201Tl Scintigraphy and Low-Dose Dobutamine Echocardiography for the Noninvasive Assessment of Myocardial Viability Circulation, December 1, 1996; 94(11): 2681 - 2684. [Full Text]
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A. I. McGhie and A. Weyman Searching for Hibernating Myocardium: Time to Reevaluate Investigative Strategies? Circulation, December 1, 1996; 94(11): 2685 - 2688. [Full Text]
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P. Perrone-Filardi, L. Pace, M. Prastaro, F. Squame, S. Betocchi, A. Soricelli, F. Piscione, C. Indolfi, T. Crisci, M. Salvatore, et al. Assessment of Myocardial Viability in Patients With Chronic Coronary Artery Disease: Rest–4-Hour–24-Hour 201Tl Tomography Versus Dobutamine Echocardiography Circulation, December 1, 1996; 94(11): 2712 - 2719. [Abstract] [Full Text]
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C. R. deFilippi, D. L. Willett, W. N. Irani, E. J. Eichhorn, C. E. Velasco, and P. A. Grayburn Comparison of Myocardial Contrast Echocardiography and Low-Dose Dobutamine Stress Echocardiography in Predicting Recovery of Left Ventricular Function After Coronary Revascularization in Chronic Ischemic Heart Disease Circulation, November 15, 1995; 92(10): 2863 - 2868. [Abstract] [Full Text]
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