Comparison of Contrast Enhanced Low-Dose Dobutamine Stress Echocardiography with 99mTc-Sestamibi Single-Photon Emission Computed Tomography in Assessment of Myocardial Viability

Abstract

INTRODUCTION: Dobutamine stress echocardiography (DSE) and myocardial perfusion scan are the commonly used modalities to detect viable myocardium. DSE is comparatively cheaper and widely available but has a lower sensitivity.
 AIM: We aimed to compare contrast-enhanced low-dose dobutamine echocardiography (LDDE) and gated 99mTc-sestamibi myocardial perfusion scan (MPS) for the degree of agreement in the detection of myocardial viability.
 METHODS: We studied 850 left ventricular segments from 50 patients (42 men, mean age 55.5 years), with coronary artery disease and left ventricular systolic dysfunction (ejection fraction < 40%), using contrast-enhanced LDDE and 99mTc-Sestamibi gated SPECT. Segments were assessed for the presence of viability by both techniques and head to head comparisons were made.
 RESULTS: Adequate visualisation increased from 80% in unenhanced segments to 96% in contrast-enhanced segments. Of the total 850 segments studied, 290 segments (34.1%) had abnormal contraction (dysfunctional). Among these, 138 were hypokinetic (16.2% of total), 144 were severely hypokinetic or akinetic (16.9% of total), and 8 segments were dyskinetic or aneurismal (0.9% of total). Among 151 segments considered viable by technetium, 137 (90.7%) showed contractile improvement with dobutamine; in contrast, only 8 of the 139 segments (5.7%) considered nonviable by technetium had a positive dobutamine response. The per cent of agreement between technetium uptake and a positive response to dobutamine was 78.6% with kappa = 0.63, suggestive of a substantial degree of agreement between the two modalities.
 CONCLUSION: Use of contrast-enhanced LDDE significantly increased the adequate endocardial border visualisation. Furthermore, this study showed a strong degree of agreement between the modalities in the detection of viable segments. So, contrast-enhanced LDDE appears to be a safe and comparable alternative to MPS in myocardial viability assessment.

Comparison of myocardial contrast stress-echocardiography and standard stress-echocardiography in detecting myocardial ischemia in patients with different severity of coronary artery stenoses

“…Использование контрастного препарата улучшало визуализацию границ эндокарда ЛЖ как в покое, так и во время нагрузки, что облегчало ин-терпретацию результатов исследования, а также позволяло более точно оценивать распространенность и степень выраженности ишемии миокарда. Количество сегментов с удовлетворительной визуализацией увеличилось почти на 15%, что соответствует данным, полученным в мировой практике [8]. Преимущества МКСЭ над стандартной стресс-ЭхоКГ неоднократно подтверждались различными исследованиями в прошлом [9][10][11], однако по-прежнему относительно невелико число исследований, в которых проводилась проба с физической нагрузкой.…”

Scintigraphy After Various Methods of Myocardial Revascularization

“…Currently, the determination of the functional state of the myocardium through the gated-SPECT method is important in assessing its viability and in predicting the recovery of ischemic cardiomyocytes [1][2][3][4][5].…”

Scintigraphy after Various Methods of Myocardial Revascularization

“…Currently, the determination of the functional state of the myocardium through the gated-SPECT method is important in assessing its viability and in predicting the recovery of ischemic cardiomyocytes [1][2][3][4][5].…”