Sensitivity, specificity, and predictive accuracies of non-invasive tests, singly and in combination, for diagnosis of hibernating myocardium.
OBJECTIVE
To determine the best test(s) for predicting functional recovery of hibernating myocardium after reperfusion.


METHODS
A prospective study to compare echocardiographic left ventricular diastolic wall thickness (> or =5 mm), low-dose dobutamine echocardiography and rest-redistribution thallium-201 scintigraphy, alone and in combination, for predicting recovery of left ventricular akinesis after surgical revascularization.


RESULTS
Twenty-eight consecutive patients aged 58+/-9 years were studied. Of the 448 left ventricular segments, 263 were akinetic at rest; 230/263 (87%) had wall thickness > or =5 mm, 135 (51%) had a positive response and 175 (66.5%) were graded viable on thallium. Of akinetic segments 61% improved after surgery. Left ventricular score decreased from 2.3+/-0.4 to 1.8+/-0.4 (P<0.01) and ejection fraction increased from 27+/-10 to 37+/-14% (P<0.01). For predicting results at 1 year, diastolic wall thickness had a sensitivity and a predictive accuracy of a negative test of 100% but a specificity of 28% and predictive accuracy of a positive test of 61%. The addition of dobutamine echocardiography or thallium-201 improved the predictive accuracy of a positive test to 76% and 69%, respectively; the addition of both tests was not of greater benefit than that of a single test.


CONCLUSIONS
Diastolic wall thickness <5 mm on echocardiography was the best simple and single predictor of non-recovery of left ventricular dysfunction. The addition of dobutamine echocardiography or thallium-201, but not both, was the best solution for predicting recovery of left ventricular dysfunction. In times of limited resources, these findings are important from a clinical point of view.
La Canna
G
G
Cattedra di Cardiologia, Università degli Studi di Brescia, Brescia, Italy.
Rahimtoola
S H
SH
Visioli
O
O
Giubbini
R
R
Alfieri
O
O
Zognio
M
M
Milan
E
E
Ceconi
C
C
Gargano
M
M
Lo Russo
R
R
Ferrari
R
R
D000328:Adult; D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage; D003971:Diastole; D004280:Dobutamine / Q000008:administration & dosage; D004452:Echocardiography; D005080:Exercise Test; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007262:Infusions, Intravenous; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009204:Myocardial Revascularization; D017682:Myocardial Stunning / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery; D011379:Prognosis; D011446:Prospective Studies; D015635:Radionuclide Ventriculography; D020127:Recovery of Function / Q000502:physiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013794:Thallium Radioisotopes; D016277:Ventricular Function, Left / Q000502:physiology
D002316:Cardiotonic Agents; D013794:Thallium Radioisotopes; D004280:Dobutamine