title: Clinical utility of low dose dobutamine echocardiography in regional myocardial viability detection before and after surgical revascularization.
abstract: 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.
authors.affiliation: Department of Cardiology, Casa de Galicia, Montevideo, Uruguay. yayo@adinet.com.uy
authors.forename: Juan Batista González
authors.initials: JB
authors.lastname: Moreno
authors.forename: Alvaro
authors.initials: A
authors.lastname: Beltrán
authors.forename: Jorge
authors.initials: J
authors.lastname: Pouso
authors.forename: Antonio
authors.initials: A
authors.lastname: Ortiz
authors.forename: Mario
authors.initials: M
authors.lastname: Lado
authors.forename: Gustavo
authors.initials: G
authors.lastname: Galain
authors.forename: Luis
authors.initials: L
authors.lastname: Filgueira
authors.forename: Ramón
authors.initials: R
authors.lastname: Scola
authors.forename: Daniel
authors.initials: D
authors.lastname: Bigalli
authors.forename: Daniel
authors.initials: D
authors.lastname: Brusich
authors.forename: Adriana
authors.initials: A
authors.lastname: De Lilla
authors.forename: Nenufar
authors.initials: N
authors.lastname: Di Paola
authors.forename: Laura
authors.initials: L
authors.lastname: Firpi
authors.forename: Enrique
authors.initials: E
authors.lastname: Besada
mesh_terms: 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
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine