Detecting viable myocardium and predicting functional improvement: comparisons of positron emission tomography, rest-redistribution thallium-201 single-photon emission computed tomography (SPECT), exercise thallium-201 reinjection SPECT, I-123 BMIPP SPECT and dobutamine stress echocardiography.
BACKGROUND
Low-dose dobutamine stress echocardiography (LDDE) has become a useful and safe method for identifying hibernating or stunned myocardium and for predicting improvement in wall motion after coronary revascularization.


RESULTS
In the present study, fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET), rest-redistribution thallium-201 ((201)Tl) single-photon emission computed tomography (RR-Tl SPECT), (123)I-15-(p-iodophenyl)-3-(R,S)-methyl pentadecanoic acid (BMIPP) and LDDE were performed in 30 patients with acute myocardial infarction (AMI) at 10+/-3 days after the onset of AMI. Also, exercise (201)Tl reinjection SPECT (RI-Tl SPECT) was performed at 14+/-2 days. Follow-up echocardiography was performed 5+/-3 months later in all patients after interventional therapy for the assessment of functional recovery. Of the 390 segments analyzed by echocardiography, 110 (28%) had abnormal wall motion. There were no significant differences between RR-Tl SPECT and LDDE in sensitivity, specificity, positive predictive value and negative predictive value using the chi(2)-test; however, in akinetic segments, there was a significant difference in sensitivity. Among FDG-PET, RI-Tl SPECT, BMIPP and LDDE, there were significant differences in 3 variables. In akinetic segments, LDDE is superior to RR-Tl SPECT in sensitivity and to FDG-PET in specificity. In hypokinetic segments, LDDE is superior to RI-Tl SPECT and BMIPP in sensitivity, and to FDG-PET and BMIPP in specificity.


CONCLUSIONS
LDDE could detect functional recovery of viable myocardium in the early period of AMI and can be performed easily and safely.
Tani
Tomoko
T
First Department of Internal Medicine, Osaka City University Medical School, Japan.
Teragaki
Masakazu
M
Watanabe
Hiroyuki
H
Muro
Takashi
T
Yamagishi
Hiroyuki
H
Akioka
Kaname
K
Yoshiyama
Minoru
M
Takeuchi
Kazuhide
K
Yoshikawa
Junichi
J
D000368:Aged; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D004280:Dobutamine / Q000008:administration & dosage*; D025401:Echocardiography, Stress / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017682:Myocardial Stunning / Q000175:diagnosis*; D049268:Positron-Emission Tomography / Q000379:methods*; D013794:Thallium Radioisotopes; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
D002316:Cardiotonic Agents; D013794:Thallium Radioisotopes; D004280:Dobutamine