title: Low dose dobutamine echocardiography is more predictive of reversible dysfunction after acute myocardial infarction than resting single photon emission computed tomographic thallium-201 scintigraphy.
abstract: To directly compare dobutamine echocardiography and resting single photon emission computed tomographic (SPECT) thallium-201 (Tl-201) scintigraphy for the detection of reversible dysfunction, 64 patients underwent dobutomine echocardiography (baseline, low dose 5 and 10 mg/kg/min, and peak dose), rest Tl-201 scintigraphy (3 mCi - 15 minute and 3- to 4-hour SPECT imaging), and coronary angiography during the first week after acute myocardial infarction. Follow-up echocardiography was performed 4 to 8 weeks after discharge. Wall thickening improved at follow-up in 52% (207 of 399) of the dysfunctional segments. By receiver operating characteristic analysis, biphasic responses and sustained improvement during dobutamine echocardiography were more accurate (p < 0.01) than Tl-201 uptake by SPECT scintigraphy for reversible dysfunction. The greater accuracy of dobutamine echocardiography resulted from higher accuracy in akinetic segments, Q wave infarction, and multivessel coronary artery disease. In conclusion, dobutamine echocardiography was more accurate than resting SPECT Tl-201 scintigraphy for reversible dysfunction after acute myocardial infarction.
authors.affiliation: Department of Medicine, Medical College of Wisconsin, and the Zablocki Veterans Administration Medical Center, Milwaukee 53226, USA.
authors.forename: S
authors.initials: S
authors.lastname: Smart
authors.forename: T
authors.initials: T
authors.lastname: Stoiber
authors.forename: R
authors.initials: R
authors.lastname: Hellman
authors.forename: J
authors.initials: J
authors.lastname: Duchak
authors.forename: J
authors.initials: J
authors.lastname: Wynsen
authors.forename: M
authors.initials: M
authors.lastname: Kitapci
authors.forename: A
authors.initials: A
authors.lastname: Isitman
authors.forename: A
authors.initials: A
authors.lastname: Krasnow
authors.forename: B D
authors.initials: BD
authors.lastname: Collier
authors.forename: K
authors.initials: K
authors.lastname: Sagar
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D002316:Cardiotonic Agents; D017023:Coronary Angiography; D004280:Dobutamine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D013794:Thallium Radioisotopes; D015912:Thrombolytic Therapy; D015899:Tomography, Emission-Computed, Single-Photon; D014463:Ultrasonography
chemical_list: D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D013794:Thallium Radioisotopes; D004280:Dobutamine