Prediction of long-term effects of revascularization on regional and global left ventricular function by dobutamine echocardiography and rest Tl-201 imaging alone and in combination in patients with chronic coronary artery disease.
BACKGROUND
The aim of this study was to evaluate the accuracy of low-dose dobutamine echocardiography (DE) and resting thallium 201 single photon emission computed tomography (SPECT) alone and in combination for prediction of functional recovery at late follow-up (1 year) after revascularization.


RESULTS
Twenty-six patients with coronary artery disease and ventricular dysfunction (ejection fraction, 42% +/- 9%) underwent DE and Tl-201 SPECT 14 +/- 9 (mean +/- SD) days before revascularization and repeated echocardiography 12 +/- 5 months thereafter. Discriminant analysis was applied to combine Tl-201 SPECT and DE data to classify dysfunctional segments as viable or nonviable. In 78 akinetic/dyskinetic revascularized segments, Tl-201 SPECT provided a sensitivity of 83% and a specificity of 55%, whereas DE showed a sensitivity of 60% and a specificity of 91%, for prediction of improvement in regional function at follow-up. The combination of data through use of discriminant analysis provided a sensitivity of 80% and a specificity of 86%, with an overall accuracy of 82%, significantly higher than DE (71%; P <.05) and Tl-201 SPECT (73%; P <.05) alone. Moreover, discriminant analysis identified 12 (75%) of 16 patients with and 8 (80%) of 10 patients without significant improvement in ejection fraction at follow-up, with an accuracy of 77%.


CONCLUSIONS
The combination of Tl-201 SPECT and DE data provides higher accuracy than either technique alone for prediction of recovery of regional and global function after revascularization.
Dellegrottaglie
Santo
S
Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Naples, Italy.
Perrone-Filardi
Pasquale
P
Pace
Leonardo
L
Prastaro
Mariella
M
Della Morte
Anna Maria
AM
Ponticelli
Maria Paola
MP
Piscione
Federico
F
Storto
Giovanni
G
De Luca
Giuseppe
G
Salvatore
Marco
M
Chiariello
Massimo
M
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009204:Myocardial Revascularization; D015588:Observer Variation; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology
D013794:Thallium Radioisotopes; D004280:Dobutamine