TY - JOUR
T1 - Prediction of left ventricular functional recovery by dobutamine echocardiography, F-18 deoxyglucose or 99mTc sestamibi nuclear imaging in patients with chronic myocardial infarction
AU - Lund, Gunnar K.
AU - Freyhoff, Jörg
AU - Schwaiger, Markus
AU - Lübeck, Martin
AU - Lund, Christian H.
AU - Buchert, Ralph
AU - Sheehan, Florence H.
AU - Meinertz, Thomas
AU - Nienaber, Christoph A.
PY - 2002
Y1 - 2002
N2 - Background: Currently, several modalities are available to predict viability, however, studies comparing various modalities validated by functional recovery after revascularization are scarce. This study analyzed the relative merits of low-dose dobutamine echocardiography, F-18 deoxyglucose (FDG) positron emission tomography (PET) and 99mTc sestamibi single-photon emission computed tomography to predict functional recovery after revascularization in patients with chronic myocardial infarction. Methods: Patients with chronic coronary occlusion (duration: 3.1 ± 4.8 years) and impaired left ventricular function (ejection fraction: 42 ± 13%) underwent low-dose dobutamine echocardiography (20 μg/kg/min), FDG-PET and 99mTc sestamibi imaging before revascularization. Revascularization was performed irrespective of any viability data. Follow-up angiography was obtained 4.8 ± 2.5 months after revascularization. Results: Viability analysis was performed in 34 patients with patent target vessel at follow-up, of whom 9 (27%) exhibited functional recovery on left ventricular angiography. For dobutamine echocardiography, improvement of ≥ 2 adjacent akinetic segments resulted in improved sensitivity of 89% and specificity of 80% to predict functional recovery. For glucose metabolism, FDG uptake >55% was an optimal threshold yielding a sensitivity of 89% and a specificity of 68%. With respect to perfusion, 99mTc sestamibi uptake >60% was the best cutoff resulting in a sensitivity and a specificity of 56 and 88%, respectively. A concordant match of FDG >55% and of 99mTc sestamibi >50% resulted in optimized sensitivity (78%) and specificity (80%) with dual imaging. Conclusions: Recovery of chronically dysfunctional myocardium can be predicted with high accuracy by stimulation of contractile reserve or by concordant match of preserved glucose metabolism and residual perfusion.
AB - Background: Currently, several modalities are available to predict viability, however, studies comparing various modalities validated by functional recovery after revascularization are scarce. This study analyzed the relative merits of low-dose dobutamine echocardiography, F-18 deoxyglucose (FDG) positron emission tomography (PET) and 99mTc sestamibi single-photon emission computed tomography to predict functional recovery after revascularization in patients with chronic myocardial infarction. Methods: Patients with chronic coronary occlusion (duration: 3.1 ± 4.8 years) and impaired left ventricular function (ejection fraction: 42 ± 13%) underwent low-dose dobutamine echocardiography (20 μg/kg/min), FDG-PET and 99mTc sestamibi imaging before revascularization. Revascularization was performed irrespective of any viability data. Follow-up angiography was obtained 4.8 ± 2.5 months after revascularization. Results: Viability analysis was performed in 34 patients with patent target vessel at follow-up, of whom 9 (27%) exhibited functional recovery on left ventricular angiography. For dobutamine echocardiography, improvement of ≥ 2 adjacent akinetic segments resulted in improved sensitivity of 89% and specificity of 80% to predict functional recovery. For glucose metabolism, FDG uptake >55% was an optimal threshold yielding a sensitivity of 89% and a specificity of 68%. With respect to perfusion, 99mTc sestamibi uptake >60% was the best cutoff resulting in a sensitivity and a specificity of 56 and 88%, respectively. A concordant match of FDG >55% and of 99mTc sestamibi >50% resulted in optimized sensitivity (78%) and specificity (80%) with dual imaging. Conclusions: Recovery of chronically dysfunctional myocardium can be predicted with high accuracy by stimulation of contractile reserve or by concordant match of preserved glucose metabolism and residual perfusion.
KW - Chronic myocardial dysfunction
KW - Dobutamine echocardiography
KW - F-18 deoxyglucose
KW - Positron emission tomography
KW - Receiver-operating characteristic curve analysis
KW - Single photon emission computed tomography
KW - Tc sestamibi
KW - Viability testing
UR - http://www.scopus.com/inward/record.url?scp=0036957696&partnerID=8YFLogxK
U2 - 10.1159/000067311
DO - 10.1159/000067311
M3 - Article
C2 - 12566650
AN - SCOPUS:0036957696
SN - 0008-6312
VL - 98
SP - 202
EP - 209
JO - Cardiology (Switzerland)
JF - Cardiology (Switzerland)
IS - 4
ER -