Dobutamine echocardiography and thallium-201 imaging predict functional improvement after revascularisation in severe ischaemic left ventricular dysfunction.

Abstract

Objectives-To evaluate the concordance between thallium-201 uptake and echocardiographic wall thickening, which are both indicators of potentially reversible myocardial dysfunction, in patients with chronic ischaemic left ventricular failure and to assess their relative contribution to predicting improvement in regional function after revascularisation in a subgroup. Patients and methods-45 patients with chronic ischaemic left ventricular dysfunction (mean (SD) ejection fraction 25 (8)%) underwent echocardiography before and after dobutamine infusion (10 4uglkglmin). Of these, 22 patients underwent rest echocardiography at a mean (SD) of 9 (1) weeks after revascularisation. 201Tl imaging was performed during dobutamine echocardiography and at rest, 1, and 4 h after treatment with sublingual glyceryl trinitrate on two separate days. Potentially reversible dysfunction was thought to be present when a myocardial segment contained a T1 score of > 3 (ascending score 1-4), or showed improved wall thickening of a dysynergic segment during dobutamine stimulation. Results-Of the 201TI protocols, the redistribution scan 1 h after treatment with glyceryl trinitrate best demonstrated myocardial viability. Concordance between 201TI and dobutamine induced wall thickening was 82% (Kc = 0.59) for detecting potentially reversible myocardial dysfunction before revascularisation (n = 45). Regional function improved in 18 of 22 patients after revascularisation. There were 168 dysynergic segments before intervention. The sensitivity of echocardiography and 201TI imaging for detecting "recoverable" or viable segments after revascularisation was 87% and 92% respectively and specificity was 82% and 78% respectively (P = NS). Conclusions-Dobutamine echocardiography and I0'Tl imaging may be used to predict mechanical improvement in dysynergic segments after revascularisation in patients with chronic ischaemic left ventricular dysfunction. (Br Heart J 1995;74:358-364)

Dobutamine echocardiography predicts functional outcome after revascularisation in patients with dysfunctional myocardium irrespective of the perfusion pattern on resting thallium-201 imaging

“…6 7 15 Dobutamine is a synthetic β 1 agonist with additional α 1 and β 2 stimulating properties 16. At low dose it detects contractile reserve in dysfunctional myocardium by recruiting contractile proteins.…”

Value of thallium-201 imaging in detecting adverse cardiac events after myocardial infarction and thrombolysis: a follow up of 100 consecutive patients

“…Separate day rest 201 Tl imaging was performed within five days of the exercise imaging. To avoid the difficulties of inadequate redistribution, 201 Tl was injected 10 minutes after sublingual nitroglycerine (0.5 mg), and imaging was performed 60 minutes later 10. Correct angulation was obtained for each image, and the position of the patient was strictly controlled.…”

Noninvasive evaluation of ischaemic heart disease: myocardial perfusion imaging or stress echocardiography?

“…[50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66][67] The lower specificity of nuclear imaging can again be an issue of duration of follow-up. Recent data have demonstrated that a substantial percentage of segments need longer time after revascularisation to (fully) recover in function.…”