This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Kostopoulos, K. G. Articles by Anthopoulos, L. P. Search for Related Content PubMed PubMed Citation Articles by Kostopoulos, K. G. Articles by Anthopoulos, L. P. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Heart Attack Nuclear Scans Social Bookmarking                         What's this?

Detection of Myocardial Viability in the Prediction of Improvement in Left Ventricular Function After Successful Coronary Revascularization by Using the Dobutamine Stress Echocardiography and Quantitative SPECT Rest-Redistribution-Reinjection 201TI Imaging After Dipyridamole Infusion

First Department of Cardiology, Athens, Greece.

Athanasios I. Kranidis, M.D.

First Department of Cardiology, Athens, Greece.

Konstantina P. Bouki, M.D.

First Department of Cardiology, Athens, Greece.

John P. Antonellis, M.D.

Departments of Hemodynamics, Athens, Greece.

Kostas G. Kappos, M.D.

First Department of Cardiology, Athens, Greece.

Fivi E. Rodogianni, M.D.

Departments of 'Nuclear Medicine, Athens, Greece.

Nikolaos J. Zamanis, M.D.

First Department of Cardiology, Athens, Greece.

Anthony G. Tavernarakis, M.D.

Departments of Hemodynamics, Athens, Greece.

Christos T. Lolas, M.D.

Departments of Cardiac Surgery of "Evangelismos" General Hospital, Athens, Greece.

Lambros P. Anthopoulos, M.D., F.A.C.C., F.E.S.C.

First Department of Cardiology, Athens, Greece.

The aim of this study was to assess the feasibility, safety, and respective diagnostic accuracy of low-dose dobutamine infusion and rest-redistribution-reinjection thallium 201 single photon emission computed tomography (SPECT) after dipyridamole infusion (Th-DIP), in the prediction of functional improvement of asynergic infarcted zones, after successful revascularization in patients with chronic ischemic heart disease. Thirty-one patients with a previous myocardial infarction and left ventricular dysfunction (mean ejection fraction: 41 ±5.8%) were studied. The regional wall motion of the left ventricle was evaluated by basic echocardiography before and 14 ± 1.7 weeks after successful revascularization (19 by percutaneous transluminal coronary angioplasty and 12 by coronary artery bypass grafting). Dobutamine stress echocardiography (DSE) was performed in all patients with dobutamine infusion of 5 and 10 µg/kg/minute over five minutes. Within three days after DSE and prior to revascularization, all patients underwent Th-DIP for myocardial viability assessment. A 16-ventricular-segment model was used for basic, DSE, and Th-DIP images. Viability was assessed by applying the (continued on next page) standard criteria for each technique. In the 31 patients, 496 segments were analyzed. By basic echocardiography, 164 (33%) of them were classified as asynergic. The DSE detected viable tissue in 69/496 (14%) segments, whereas Th-DIP identified viability in 95/496 (19%) segments. When the postrevascularization basic echocardiographic study was used as the gold standard in identifying myocardial viability, the sensitivity and specificity for the DSE and Th-DIP were 86.5%, 94.4% and 90.5%, 69%, respectively. No major side effects were observed with both techniques.

In conclusion, DSE seems to be an accurate method for identifying viable but asynergic myocardium in patients with chronic ischemic heart disease, whereas Th-DIP overestimates the postrevascularization recovery. Detection of hibernating myocardium can be obtained by these two noninvasive methods. However, DSE seems to be more useful in determining the prospective selection of patients who are going to benefit from revascularization.

Angiology, Vol. 47, No. 11, 1039-1046 (1996)
DOI: 10.1177/000331979604701103


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?