title: Prediction of recovery of myocardial dysfunction after revascularization. Comparison of fluorine-18 fluorodeoxyglucose/thallium-201 SPECT, thallium-201 stress-reinjection SPECT and dobutamine echocardiography.
abstract: OBJECTIVE
  We compared three techniques to predict functional recovery after revascularization.
  
  
  BACKGROUND
  Recently, fluorine-18 (F-18) fluorodeoxyglucose in combination with single-photon emission computed tomography (SPECT) has been proposed to identify viable myocardium, Thallium-201 reinjection and low dose dobutamine echocardiography are used routinely for this purpose.
  
  
  METHODS
  Seventeen patients (mean [+/- SD] left ventricular ejection fraction 36 +/- 11%) were studied. Regional and global ventricular function were evaluated before and 3 months after revascularization by echocardiography and radionuclide ventriculography, respectively. Myocardial F-18 fluorodeoxyglucose uptake (during hyperinsulinemic glucose clamping) was compared with rest perfusion assessed with early thallium-201 SPECT. On a separate day, low dose dobutamine echocardiography and post-stress thallium-201 reinjection SPECT were simultaneously performed.
  
  
  RESULTS
  The sensitivities for F-18 fluorodeoxyglucose/thallium-201, thallium-201 reinjection and low dose dobutamine echocardiography to assess recovery were 89%, 93% and 85%, respectively; specificities were 77%, 43% and 63%, respectively. Stepwise logistic regression indicated that F-18 fluorodeoxyglucose/ thallium-201 was the best predictor. In hypokinetic segments, the combination of F-18 fluorodeoxyglucose/thallium-201 and low dose dobutamine echocardiography was the best predictor. Global function improved (left ventricular ejection fraction increased > 5%) in 6 patients and remained unchanged in 11. All three techniques correctly identified five of six patients with improvement. Fluorine-18 fluorodeoxyglucose/thallium-201 identified all patients without improvement; low dose dobutamine echocardiography identified 9 of 11 without improvement; and thallium-201 reinjection identified 6 of 11 patients without improvement.
  
  
  CONCLUSIONS
  Fluorine-18 fluorodeoxyglucose/thallium-201 SPECT was superior to the other techniques in assessing functional recovery. Integration of metabolic and functional data is necessary, particularly in hypokinesia, for optimal prediction of improvement of regional function.
authors.affiliation: Department of Cardiology, Free University Hospital Amsterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Bax
authors.forename: J H
authors.initials: JH
authors.lastname: Cornel
authors.forename: F C
authors.initials: FC
authors.lastname: Visser
authors.forename: P M
authors.initials: PM
authors.lastname: Fioretti
authors.forename: A
authors.initials: A
authors.lastname: van Lingen
authors.forename: A E
authors.initials: AE
authors.lastname: Reijs
authors.forename: E
authors.initials: E
authors.lastname: Boersma
authors.forename: G J
authors.initials: GJ
authors.lastname: Teule
authors.forename: C A
authors.initials: CA
authors.lastname: Visser
mesh_terms: D000328:Adult; D000368:Aged; D003847:Deoxyglucose / Q000031:analogs & derivatives; D004280:Dobutamine; D004452:Echocardiography; D005260:Female; D005462:Fluorine Radioisotopes; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D014022:Tissue Survival; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D005462:Fluorine Radioisotopes; D013794:Thallium Radioisotopes; D019788:Fluorodeoxyglucose F18; D004280:Dobutamine; D003847:Deoxyglucose