Comparison of dobutamine transesophageal echocardiography and dobutamine magnetic resonance imaging for detection of residual myocardial viability.
A dobutamine-induced contraction reserve in akinetic but viable myocardium, observed by echocardiography or magnetic resonance imaging (MRI), is a reliable indicator of myocardial viability. However, the comparative diagnostic accuracy of these 2 techniques is unknown. Therefore, 43 patients with myocardial infarction (infarct age > or = 4 months) and regional akinesia underwent dobutamine transesophageal echocardiography (TEE) and dobutamine MRI (10 microg dobutamine/ min/kg). Both imaging techniques were compared with the reference standard 18F-fluorodeoxyglucose positron emission tomography (FDG PET). An infarct region was considered viable if a dobutamine contraction reserve could be assessed visually by TEE or quantitatively by MRI in > or = 50% of segments graded "a" or dyskinetic at rest. Infarct regions were graded viable by PET if FDG uptake was > or = 50% of the maximal FDG uptake in a region with normal wall motion by left ventriculography. A dobutamine contraction reserve was found in 21 of 43 patients (49%) by TEE and MRI. A viable infarct region by FDG PET was diagnosed in 26 of 43 patients (60%). FDG uptake and dobutamine TEE were concordant in 36 of 43 patients (84%) and dobutamine MRI and FDG PET were concordant in 38 of 43 patients (88%). Sensitivity and specificity of dobutamine TEE and dobutamine MRI for FDG PET-defined myocardial viability were 77% versus 81% and 94% versus 100%, respectively. Both imaging techniques yielded similar results for the detection of myocardial viability as defined by FDG uptake, with a slightly higher sensitivity and specificity for the quantitatively evaluated dobutamine contraction reserve by MRI.
Baer
F M
FM
Klinik III für Innere Medizin, Universität zu Köln, Germany.
Voth
E
E
LaRosée
K
K
Schneider
C A
CA
Theissen
P
P
Deutsch
H J
HJ
Schicha
H
H
Erdmann
E
E
Sechtem
U
U
D000318:Adrenergic beta-Agonists; D000328:Adult; D000368:Aged; D003847:Deoxyglucose / Q000031:analogs & derivatives; D004280:Dobutamine; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D015637:Gated Blood-Pool Imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009203:Myocardial Infarction / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000503:physiopathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D014022:Tissue Survival; D014055:Tomography, Emission-Computed; D016277:Ventricular Function, Left
D000318:Adrenergic beta-Agonists; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D004280:Dobutamine; D003847:Deoxyglucose