title: Myocardial viability estimation during the recovery phase of stress echocardiography after acute beta-blocker administration.
abstract: BACKGROUND
  Myocardial viability assessment in severely dysfunctional segments by dobutamine stress echocardiography (DSE) is less sensitive than nuclear scanning.
  
  
  OBJECTIVE
  To assess the additional value of using the recovery phase of DSE after acute beta-blocker administration for identifying viable myocardium.
  
  
  METHODS
  The study included 49 consecutive patients with ejection fraction (LVEF)<or=35%. All patients underwent DSE evaluation at low-high dose and during recovery phase, and dual-isotope single photon emission tomography (DISA-SPECT) evaluation for viability of severely dysfunctional segments. Patients with >or=4 viable segments were considered viable. Coronary revascularization followed within 3 months in all patients. Radionuclide evaluation of LVEF was performed before and 12 months after revascularization.
  
  
  RESULTS
  Viability with DISA-SPECT was detected in 463 (59%) segments, while 154 (19.7%) segments presented as scar. The number of viable segments increased from 415 (53%) at DSE to 463 (59%) at DSE and recovery, and the number of viable patients increased from 43 to 49 respectively. LVEF improved by >or=5% in 27 patients. Multivariate regression analysis showed that, DSE with recovery phase was the only independent predictor of >or=5% LVEF improvement after revascularization (OR 14.6, CI 1.4-133.7).
  
  
  CONCLUSIONS
  In this study, we demonstrate that the recovery phase of DSE has an increased sensitivity for viability estimation compared to low-high dose DSE.
authors.affiliation: Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Stefanos E
authors.initials: SE
authors.lastname: Karagiannis
authors.forename: Harm H H
authors.initials: HH
authors.lastname: Feringa
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.forename: Abdu
authors.initials: A
authors.lastname: Elhendy
authors.forename: Martin
authors.initials: M
authors.lastname: Dunkelgrun
authors.forename: Radosav
authors.initials: R
authors.lastname: Vidakovic
authors.forename: S E
authors.initials: SE
authors.lastname: Hoeks
authors.forename: Ron
authors.initials: R
authors.lastname: van Domburg
authors.forename: Roelf
authors.initials: R
authors.lastname: Valhema
authors.forename: Dennis V
authors.initials: DV
authors.lastname: Cokkinos
authors.forename: Don
authors.initials: D
authors.lastname: Poldermans
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000494:pharmacology*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000503:physiopathology; D025401:Echocardiography, Stress; D005260:Female; D006321:Heart / Q000187:drug effects*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D015635:Radionuclide Ventriculography; D020127:Recovery of Function; D013318:Stroke Volume; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000319:Adrenergic beta-Antagonists