title: End-diastolic wall thickness as a predictor of recovery of function in myocardial hibernation: relation to rest-redistribution T1-201 tomography and dobutamine stress echocardiography.
abstract: OBJECTIVE
  The study assessed whether end-diastolic wall thickness (EDWT), measured with echocardiography, is an important marker of myocardial viability in patients with suspected myocardial hibernation, and it compared this index to currently established diagnostic modalities of dobutamine stress echocardiography (DSE) and rest-redistribution thallium-201 (T1-201) scintigraphy.
  
  
  BACKGROUND
  Because myocardial necrosis is associated with myocardial thinning, preserved EDWT may provide a simple index of myocardial viability that is readily available from the resting echocardiogram.
  
  
  METHODS
  Accordingly, 45 patients with stable coronary artery disease and ventricular dysfunction underwent rest 2D echocardiograms, DSE and rest-redistribution T1-201 tomography before revascularization and a repeat resting echocardiogram > or =2 months later.
  
  
  RESULTS
  Global wall motion score index decreased from 2.38 +/- 0.73 to 1.94 +/- 0.82 after revascularization (p < 0.001). Thirty-eight percent of severely dysfunctional segments recovered resting function. Compared to segments without recovery of resting function, those with recovery had greater EDWT (0.94 +/- 0.18 cm vs. 0.67 +/- 0.22 cm, p < or = 0.0001) and a higher T1-201 uptake (78 +/- 13% vs. 59 +/- 21%; p < 0.0001). An EDWT >0.6 cm had a sensitivity of 94% and specificity of 48% for recovery of function. Similarly, a T1-201 maximal uptake of > or =60% had a sensitivity of 91% and specificity of 50%. Receiver operating characteristic curves for prediction of recovery of regional and global function were similar for EDWT and maximum T1-201 uptake. Combination of EDWT and any contractile reserve during DSE for recovery of regional function improved the specificity to 77% without a significant loss in sensitivity (88%).
  
  
  CONCLUSIONS
  End-diastolic wall thickness is an important marker of myocardial viability in patients with suspected hibernation, and it can predict recovery of function similar to T1-201 scintigraphy. Importantly, a simple measurement of EDWT < or =0.6 cm virtually excludes the potential for recovery of function and is a valuable adjunct to DSE in the assessment of myocardial viability.
authors.affiliation: Section of Cardiology, Baylor College of Medicine, Houston, Texas 77030, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Cwajg
authors.forename: E
authors.initials: E
authors.lastname: Cwajg
authors.forename: S F
authors.initials: SF
authors.lastname: Nagueh
authors.forename: Z X
authors.initials: ZX
authors.lastname: He
authors.forename: U
authors.initials: U
authors.lastname: Qureshi
authors.forename: L I
authors.initials: LI
authors.lastname: Olmos
authors.forename: M A
authors.initials: MA
authors.lastname: Quinones
authors.forename: M S
authors.initials: MS
authors.lastname: Verani
authors.forename: W L
authors.initials: WL
authors.lastname: Winters
authors.forename: W A
authors.initials: WA
authors.lastname: Zoghbi
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents; D003327:Coronary Disease / Q000150:complications* / Q000175:diagnosis* / Q000503:physiopathology; D003971:Diastole; D004280:Dobutamine; D004452:Echocardiography / Q000592:standards*; D005080:Exercise Test / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000209:etiology*; D009336:Necrosis; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013318:Stroke Volume; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000592:standards*
chemical_list: D002316:Cardiotonic Agents; D013794:Thallium Radioisotopes; D004280:Dobutamine