title: Myocardial viability assessment after acute myocardial infarction: low-dose dobutamine echocardiography versus rest-redistribution thallium-201 SPECT.
abstract: BACKGROUND
  The presence of tissue viability is of great importance in the prognostic work-up of patients recovering from acute myocardial infarction. However, uncertainty still exists concerning the optimal tool for its assessment. The present study was undertaken in order to compare low-dose dobutamine echocardiography and rest-redistribution thallium SPECT for predicting late improvement of regional left ventricular function after acute myocardial infarction.
  
  
  METHODS
  Fifteen patients undergoing coronary angiography, low-dose dobutamine echocardiography and rest-redistribution thallium SPECT after thrombolyzed anterior acute myocardial infarction were studied. A 3 month follow-up echocardiogram was performed in all patients and 9 underwent coronary revascularization.
  
  
  RESULTS
  A significant (> or = 70%) residual stenosis of the infarct-related artery was present in 14 patients, whilst a total occlusion was observed in 1. At 3 month follow-up, 41% of the dyssynergic segments improved. The sensitivity, specificity and accuracy for late wall motion improvement was 61, 89 and 77% for low-dose dobutamine echocardiography and, respectively, 76, 45 and 58% for rest-redistribution thallium SPECT. Tissue viability was detected in 65 and 31% of dyssynergic segments by rest-redistribution thallium SPECT and low-dose dobutamine echocardiography, respectively (p < 0.001). The agreement between the two techniques was 48%.
  
  
  CONCLUSIONS
  Low-dose dobutamine echocardiography is more accurate than rest-redistribution thallium SPECT for predicting 3 month wall motion improvement in patients with acute anterior myocardial infarction, mainly due to its significantly better specificity.
authors.affiliation: Divisione di Cardiologia, Università degli Studi, Ospedale San Paolo, Milano. castini@ats.it
authors.forename: D
authors.initials: D
authors.lastname: Castini
authors.forename: A
authors.initials: A
authors.lastname: Bestetti
authors.forename: M
authors.initials: M
authors.lastname: Garbin
authors.forename: C
authors.initials: C
authors.lastname: Di Leo
authors.forename: R
authors.initials: R
authors.lastname: Bigi
authors.forename: C
authors.initials: C
authors.lastname: Sponzilli
authors.forename: G
authors.initials: G
authors.lastname: Concardi
authors.forename: M
authors.initials: M
authors.lastname: Gioventù
authors.forename: G L
authors.initials: GL
authors.lastname: Tarolo
authors.forename: F
authors.initials: F
authors.lastname: Lombardi
authors.forename: C
authors.initials: C
authors.lastname: Fiorentini
mesh_terms: D000328:Adult; D002316:Cardiotonic Agents / Q000008:administration & dosage; D017023:Coronary Angiography; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes / Q000008:administration & dosage; D014022:Tissue Survival; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
chemical_list: D002316:Cardiotonic Agents; D019275:Radiopharmaceuticals; D013794:Thallium Radioisotopes; D004280:Dobutamine