title: [The capacity of the rest-dobutamine gated SPECT protocol to predict contractile recovery after revascularization of myocardial dysinergic areas].
abstract: OBJECTIVE
  Gated-SPECT is a promising method to analyze myocardial viability. We have assessed the accuracy of a new protocol of rest/Dobutamine gated-SPECT, based on the evaluation of contractile reserve induced by 10 microg/kg/min of Dobutamine, to predict contractile recovery after revascularization of dysinergic myocardial territories.
  
  
  METHODS
  In a group of 36 patients submitted to percutaneous revascularization, we selected 40 vascular territories (21 left descending artery, 19 right coronary-circumflex) with severely depressed contractility (contrast ventriculography, center line method). Follow up evaluation at 6 months showed the absence of angiographic restenosis and control contrast ventriculography assessed the contractile changes of the selected territories, considering those with contractile restoration as viable. Before revascularization, rest/Dobutamine gated-SPECT study was applied and viability was defined as the presence of contractile reserve (positive or improvement [n = 21] and negative or impairment [n = 7]) with non viability being the absence of contractile reserve (n = 12). We analyzed the evolution of the ejection fraction in a group of 27 patients with impaired ventricular function and complete revascularization.
  
  
  RESULTS
  Gated-SPECT showed a sensitivity of 0.96 (95% CI 0.78-0.99) and a specificity of 0.78 (95% CI 0.48-0.94) in the diagnosis of viability. The ejection fraction (median [interquartile range]) increased after revascularization: 0.42 (0.15) vs 0.55 (0.22), Z = -3.9; p < 0. 001. The diagnosis of viability by gated-SPECT (p < 0.001) and the extent of severely depressed myocardium (p = 0.04) independently predicted the increase of the ejection fraction after revascularization.
  
  
  CONCLUSIONS
  The analysis of contractile reserve by rest/Dobutamine gated-SPECT is adequate to diagnose viability in territories with severely depressed contractility and independently predicts the increase of ejection fraction after revascularization.
authors.affiliation: Departamento de Cardiología Intervencionista. Hospital do Meixoeiro. Vigo.
authors.forename: R J
authors.initials: RJ
authors.lastname: Ruiz-Salmerón
authors.forename: E
authors.initials: E
authors.lastname: Ponce De León
authors.forename: A
authors.initials: A
authors.lastname: López
authors.forename: D
authors.initials: D
authors.lastname: Romeo
authors.forename: V
authors.initials: V
authors.lastname: del Campo
authors.forename: R
authors.initials: R
authors.lastname: Nandayapa
authors.forename: R
authors.initials: R
authors.lastname: Guitián
authors.forename: R
authors.initials: R
authors.lastname: Mantilla
authors.forename: F
authors.initials: F
authors.lastname: Calvo
authors.forename: J
authors.initials: J
authors.lastname: Pasalodos
authors.forename: J
authors.initials: J
authors.lastname: Goicolea
mesh_terms: D000318:Adrenergic beta-Agonists; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D004280:Dobutamine; D005260:Female; D015637:Gated Blood-Pool Imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000187:drug effects / Q000502:physiology; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D012146:Rest / Q000502:physiology*
chemical_list: D000318:Adrenergic beta-Agonists; D004280:Dobutamine