title: Low-dose dobutamine echocardiography and rest-redistribution thallium-201 tomography in the assessment of spontaneous recovery of left ventricular function after recent myocardial infarction.
abstract: Spontaneous improvement of contraction and perfusion occurs after acute myocardial infarction. The relative merit of low-dose dobutamine stress echocardiography (LDDE) and rest-redistribution thallium scintigraphy (RR TI) in this setting has not been evaluated. We studied 30 patients at 7 +/- 3 days after acute myocardial infarction with LDDE (5 to 10 micrograms/kg/min) and RR TI single photon emission computed tomography. Viability was defined as improvement of wall thickening at LDDE in the presence of redistribution or a defect with uptake > or = 50% of peak activity at RR TI. Baseline echocardiography and RR TI were repeated after 3 months. In 112 dyssynergic segments, viability was detected in 60 (54%) by RR TI and in 39 (35%) by LDDE (p < 0.005). Spontaneous improvement of function was detected in 35 (31 %) segments. In the same regions, thallium uptake increased significantly. The sensitivity, specificity, and accuracy of LDDE for predicting late improvement of wall motion were 77%, 84%, and 82%, respectively. Those of RR TI were 77%, 57%, and 63%, respectively. Specificity and accuracy of LDDE were higher than RR TI (p < 0.005). We conclude that a myocardial viability pattern after acute myocardial infarction is more frequently detected by RR TI than by LDDE. Both techniques are equally sensitive, but LDDE is a more specific predictor of spontaneous recovery of regional left ventricular function.
authors.affiliation: Thoraxcenter, University Hospital Rotterdam-Dijkzigt, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Elhendy
authors.forename: G
authors.initials: G
authors.lastname: Trocino
authors.forename: A
authors.initials: A
authors.lastname: Salustri
authors.forename: J H
authors.initials: JH
authors.lastname: Cornel
authors.forename: J R
authors.initials: JR
authors.lastname: Roelandt
authors.forename: E
authors.initials: E
authors.lastname: Boersma
authors.forename: R T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: E P
authors.initials: EP
authors.lastname: Krenning
authors.forename: G M
authors.initials: GM
authors.lastname: El-Said
authors.forename: P M
authors.initials: PM
authors.lastname: Fioretti
mesh_terms: D000318:Adrenergic beta-Agonists / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011237:Predictive Value of Tests; D012146:Rest; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D016277:Ventricular Function, Left
chemical_list: D000318:Adrenergic beta-Agonists; D013794:Thallium Radioisotopes; D004280:Dobutamine