Assessment of reversible dyssynergic segments after acute myocardial infarction: Dobutamine echocardiography versus thallium-201 single photon emission computed tomography.
Only a moderate degree of concordance has been reported between stress-redistribution-reinjection thallium-201 single photon emission computed tomography (SPECT) and dobutamine echocardiography for the identification of myocardial viability after acute myocardial infarction. SPECT with rest-reinjection performed 4 hours after exercise testing and digitized two-dimensional (2-D) ultrasound reconstruction of the left ventricle at baseline and after low-dose dobutamine (5 to 10 microg/kg/min) infusion were compared in 50 patients > or = 8 days (12 +/- 7 days) after acute myocardial infarction. Five patients were excluded because of technically inadequate echocardiograms. Both SPECT and dobutamine echocardiography were assessed in a 16-segment model and interpreted in the remaining 45 patients. Digitized 2-D reconstruction of the left ventricle in each wall motion was scored from 1 (normal) to 4 (dyskinesia). Myocardial viability was identified on ultrasound wall-motion improvement of one or more grades from baseline to echocardiography performed > or = 30 days (60 +/- 41 days) after systematic revascularization procedure of the infarct-related artery. Reversible defect under thallium-201 SPECT and wall-motion improvement under dobutamine echocardiography were concordant in 163 (69 percent) of the 235 baseline dyssynergic segments and in 30 (67 percent) patients. Myocardial viability was identified after angioplasty (n=37) or surgery (n=8) in 29 patients and 109 segments. Positive and negative predictive values per patient in the diagnosis of myocardial viability were 86 percent and 57 percent, respectively, for stress thallium-201 SPECT with reinjection, and 100 percent and 62 percent for dobutamine echocardiography. Positive and negative predictive values per segment were 80 percent and 69 percent for the isotopic method and 91 percent and 70 percent for dobutamine echocardiography. We conclude that dobutamine echocardiography and stress thallium-201 SPECT with reinjection have similar accuracies to identify myocardial viability after acute myocardial infarction, with excellent positive but relatively low negative predictive values.
Le Feuvre
C
C
Clinique Cardiologique, Hopital Necker, Paris, France.
Baubion
N
N
Aubry
N
N
Metzger
J P
JP
de Vernejoul
P
P
Vacheron
A
A
D000318:Adrenergic beta-Agonists; D000328:Adult; D000368:Aged; D004280:Dobutamine; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
D000318:Adrenergic beta-Agonists; D013794:Thallium Radioisotopes; D004280:Dobutamine