title: Post-systolic shortening during dobutamine stress echocardiography predicts cardiac survival in patients with severe left ventricular dysfunction.
abstract: BACKGROUND
  Patients with severe left ventricular dysfunction and myocardial viability by dobutamine stress echocardiography (DSE) or F18-fluorodeoxyglucose-single-photon emission computed tomography (FDG-SPECT), experience improved survival after coronary revascularization. Pulsed wave-tissue Doppler imaging (PW-TDI)-derived ejection phase shortening (EPS) and post-systolic shortening (PSS) velocities may help to quantify DSE. We assessed these variables in a prospective long-term follow-up.
  
  
  METHODS
  Eighty patients (58 men, mean age 63+/-9 years) with left ventricular dysfunction (radionuclide ventriculography mean ejection fraction, 34+/-11%) underwent both DSE and FDG-SPECT for myocardial viability. Viable myocardium was improvement from rest to low dose or worsening of wall motion at peak DSE and normal perfusion, mildly reduced perfusion with FDG uptake or severely reduced or absent perfusion with increased FDG uptake (mismatch) at FDG-SPECT. EPS, PSS velocities and EPS/PSS ratio during DSE were analysed using a six-segment model. Coronary revascularization bypass grafting was performed in 62 patients. All patients completed a long-term (9-year) follow-up for cardiac death.
  
  
  RESULTS
  The segmental prevalence of severe dyssynergy was 77%. On a patient basis myocardial viability was detected by EPS/PSS ratio (31%), FDG-SPECT (34%) and DSE (26%). A significant improvement of Kaplan-Meier survival was predicted in viable compared with nonviable revascularized patients (P < 0.01). Both EPS/PSS ratio and FDG-SPECT, compared to DSE alone, tended to allocate more accurately univariate prediction of death-free outcome (odds ratio, 2.5 and 2.7 compared with 2.1).
  
  
  CONCLUSIONS
  TDI adds objective variables to DSE, helping to recognize viable myocardium and optimize prediction of death-free outcome in long-term follow-up, with favorable comparison with nuclear techniques.
authors.affiliation: Cardiology Department, Maggiore Hospital, Bologna, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rambaldi
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rizzello
authors.forename: Elena
authors.initials: E
authors.lastname: Biagini
authors.forename: Roelf
authors.initials: R
authors.lastname: Valkema
authors.forename: Jos R T C
authors.initials: JR
authors.lastname: Roelandt
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D009202:Cardiomyopathies / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D001026:Coronary Artery Bypass; D025401:Echocardiography, Stress; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D009206:Myocardium / Q000473:pathology*; D009426:Netherlands / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013599:Systole / Q000502:physiology; D014022:Tissue Survival; D015899:Tomography, Emission-Computed, Single-Photon; D018617:Ultrasonography, Doppler, Pulsed; D018487:Ventricular Dysfunction, Left / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18