title: Improved identification of viable myocardium using second harmonic imaging during dobutamine stress echocardiography.
abstract: OBJECTIVE
  To determine whether, compared with fundamental imaging, second harmonic imaging can improve the accuracy of dobutamine stress echocardiography for identifying viable myocardium, using nuclear imaging as a reference.
  
  
  METHODS
  30 patients with chronic left ventricular dysfunction (mean (SD) age, 60 (8) years; 22 men).
  
  
  METHODS
  Dobutamine stress echocardiography was carried out in all patients using both fundamental and second harmonic imaging. All patients underwent dual isotope simultaneous acquisition single photon emission computed tomography (DISA-SPECT) with (99m)technetium-tetrofosmin/(18)F-fluorodeoxyglucose on a separate day. Myocardial viability was considered present by dobutamine stress echocardiography when segments with severe dysfunction showed a biphasic sustained improvement or an ischaemic response. Viability criteria on DISA-SPECT were normal or mildly reduced perfusion and metabolism, or perfusion/metabolism mismatch.
  
  
  RESULTS
  Using fundamental imaging, 330 segments showed severe dysfunction at baseline; 144 (44%) were considered viable. The agreement between dobutamine stress echocardiography by fundamental imaging and DISA-SPECT was 78%, kappa = 0.56. Using second harmonic imaging, 288 segments showed severe dysfunction; 138 (48%) were viable. The agreement between dobutamine stress echocardiography and DISA-SPECT was significantly better when second harmonic imaging was used (89%, kappa = 0.77, p = 0.001 v fundamental imaging).
  
  
  CONCLUSIONS
  Second harmonic imaging applied during dobutamine stress echocardiography increases the agreement with DISA-SPECT for detecting myocardial viability.
authors.affiliation: Thoraxcenter, Erasmus Medical Centre, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands.
authors.forename: F B
authors.initials: FB
authors.lastname: Sozzi
authors.forename: D
authors.initials: D
authors.lastname: Poldermans
authors.forename: J J
authors.initials: JJ
authors.lastname: Bax
authors.forename: A
authors.initials: A
authors.lastname: Elhendy
authors.forename: E C
authors.initials: EC
authors.lastname: Vourvouri
authors.forename: R
authors.initials: R
authors.lastname: Valkema
authors.forename: J
authors.initials: J
authors.lastname: De Sutter
authors.forename: A F
authors.initials: AF
authors.lastname: Schinkel
authors.forename: A
authors.initials: A
authors.lastname: Borghetti
authors.forename: J R
authors.initials: JR
authors.lastname: Roelandt
mesh_terms: D002316:Cardiotonic Agents; D004280:Dobutamine; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
chemical_list: D002316:Cardiotonic Agents; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D004280:Dobutamine