Clinical utility of low dose dobutamine echocardiography in regional myocardial viability detection before and after surgical revascularization.
Seventy-eight consecutive patients (mean 63 +/- 10 years, 79.5% men) with a history of myocardial infarction and indication of coronary artery bypass grafting (CABG) were studied with low dose dobutamine stress echocardiography (DSE) before (DSE 1) and at 3-month follow-up (DSE 2) to evaluate its clinical utility in the detection of viable myocardium. We determined the expected utilities of global patients (P; n = 67) and coronary territories (T; n = 126) with the classic strategy: DSE 1 and results of a rest follow-up echocardiogram (REST 2) and applying them to a complementary strategy that submitted false positives (Fp) and false negatives (Fn) results to DSE 2. Assigned utilities in each node of the decision tree were maximal (1.0), submaximal ( 0.75), and intermedium (0.50) using the folding method as a mathematical model.


RESULTS
Global P and T expected utilities when performing DSE 1 were 0.84 and 0.89, respectively for positive viability; 0.85 and 0.82, respectively; and for negative viability 0.83 and 0.82, respectively. The expected utilities with the decision of performing a DSE 2 to Fp were 0.74 and 0.76, respectively (viability was detected in 66% of P and in 58% of T) and 0.47 and 0.45, respectively, as applied to Fn.


CONCLUSIONS
Low dose DSE results in high clinical utility by finding viable or scar myocardium before CABG as well as when discordant results are found in follow-up, particularly with Fp.
Moreno
Juan Batista González
JB
Department of Cardiology, Casa de Galicia, Montevideo, Uruguay. yayo@adinet.com.uy
Beltrán
Alvaro
A
Pouso
Jorge
J
Ortiz
Antonio
A
Lado
Mario
M
Galain
Gustavo
G
Filgueira
Luis
L
Scola
Ramón
R
Bigalli
Daniel
D
Brusich
Daniel
D
De Lilla
Adriana
A
Di Paola
Nenufar
N
Firpi
Laura
L
Besada
Enrique
E
D002316:Cardiotonic Agents; D001026:Coronary Artery Bypass; D004280:Dobutamine; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D009206:Myocardium; D015588:Observer Variation
D002316:Cardiotonic Agents; D004280:Dobutamine