title: Prediction of functional recovery of hibernating myocardium using harmonic power Doppler imaging and dobutamine stress echocardiography in patients with coronary artery disease.
abstract: The aim of this study was to compare the accuracy of harmonic power Doppler imaging (HPDI) and dobutamine stress echocardiography (DSE) in predicting recovery of myocardial function after bypass surgery. HPDI using triggering imaging with the administration of Levovist (Shering AG, Berlin, Germany) and DSE were performed in 34 patients (mean age 64 +/- 5 years) with left ventricular dysfunction. A repeat echocardiogram at rest was performed 3 months after revascularization. Of the 408 revascularized dysfunctional segments, 188 (45%) improved on the repeat echocardiogram. HPDI exhibited overall similar sensitivity (88% vs 87%) and accuracy (74% vs 79%) but lower specificity (61% vs 72%, p<0.05) compared with DSE for predicting recovery of myocardial function. Only delayed opacification at the 1:8 triggering point, demonstrated in 62% of viable segments, exhibited higher sensitivity (63%) and positive (58%) and negative (66%) predictive values than early opacification at 1:4 (25%, p<0.001; 35%, p<0.001; and 49%, p<0.001, respectively) in predicting functional recovery. The presence of contrast enhancement within the revascularized area resulted in a significant improvement after revascularization in wall motion score index and ejection fraction compared with areas with residual contrast defect (1.9 +/- 0.3 vs 2.3 +/- 0.3, p<0.01; 36 +/- 6% vs 29 +/- 5%, p<0.01, respectively). Significant correlations were observed between the contrast score index and the follow-up wall motion score index (r = -0.67) and between the contrast score index and the follow-up ejection fraction change (r = 0.65). Triggered HPDI has high sensitivity in detecting hibernating myocardium and can accurately predict the potential for recovery of ischemic left ventricular dysfunction 3 months after revascularization.
authors.affiliation: Department of Cardiology, Hippokration Hospital, University of Athens, 47 Georgiou Papandreou Zografou, Athens, Greece 15773. caggeli@hol.gr
authors.forename: Constadina
authors.initials: C
authors.lastname: Aggeli
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
authors.forename: Maria
authors.initials: M
authors.lastname: Bonou
authors.forename: Christos
authors.initials: C
authors.lastname: Pitsavos
authors.forename: Constantinos
authors.initials: C
authors.lastname: Theocharis
authors.forename: George
authors.initials: G
authors.lastname: Roussakis
authors.forename: Constantinos
authors.initials: C
authors.lastname: Chatzos
authors.forename: Stela
authors.initials: S
authors.lastname: Brili
authors.forename: Pavlos
authors.initials: P
authors.lastname: Toutouzas
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D020820:Dyskinesias / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006115:Greece; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009204:Myocardial Revascularization; D017682:Myocardial Stunning / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D009206:Myocardium / Q000473:pathology; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery