Value of dobutamine/nitrate radionuclide angiography in predicting revascularization effects on ventricular function.
OBJECTIVE
Dobutamine and Nitrate Radionuclide Angiography (RNA) may help to distinguish viable from nonviable myocardium and to predict revascularization effects on LV function.


METHODS
Ambulatory.


METHODS
Prospective.


METHODS
We studied 12 patients (11 male, 1 female; mean age 56 +/- 10 years) with three-vessel disease, severe LV dysfunction, and prior MI for a mean follow-up time of 10 +/- 3.4 months. Thallium-201 scintigraphy favored potential viability in all patients: inducible ischemia with satisfactory perfusion in more than one coronary arterial territory. Global and regional LVEF's were calculated from preoperative RNA (baseline rest study and with continuous dobutamine infusion with gradual rate increase plus oral nitrates) and postoperative RNA at 1 and 6 months.


RESULTS
There was no operative mortality, but two late deaths occurred. Symptomatically, most patients showed improvement. Global LVEF increased during dobutamine and nitrates preoperatively (p < 0.01), but not at 1 and 6 months postoperatively (without pharmacological intervention). Mean LVED volume was not significantly changed postoperatively. Regional EF improvement was found in 4 out of 9 LV wall segments under dobutamine and nitrates, and this increase persisted postoperatively at 1 and 6 months.


CONCLUSIONS
Mild but significant increase in global LVEF during dobutamine and nitrates administration is not predictive of postoperative LVEF improvement. However, regional EF improvement appears to be predictive of post-revascularization LV functional improvement.
Schechter
D
D
Department of Medical Biophysics and Nuclear Medicine, Hadassah University Hospital, Jerusalem, Israel.
Milgalter
E
E
Bocher
M
M
Shimon
D V
DV
Borman
J B
JB
Rozenman
Y
Y
Merin
G
G
Gotsman
M S
MS
Weiss
A T
AT
Chisin
R
R
D000286:Administration, Sublingual; D000328:Adult; D000368:Aged; D001026:Coronary Artery Bypass; D004280:Dobutamine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007548:Isosorbide Dinitrate / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011875:Radionuclide Angiography; D013318:Stroke Volume; D016277:Ventricular Function, Left / Q000187:drug effects
D004280:Dobutamine; D007548:Isosorbide Dinitrate