Head-to-head comparison of exercise-redistribution-reinjection thallium single-photon emission computed tomography and low dose dobutamine echocardiography for prediction of reversibility of chronic left ventricular ischemic dysfunction

Vanoverschelde, Jean-Louis J.; D'hondt, Anne-Marie; Marwick, Thomas H.; Gerber, Bernhard; Kock, Martine De; Dion, Robert; Wijns, William; Melin, Jacques

doi:10.1016/0735-1097(96)00167-2

Cited by 125 publications

(46 citation statements)

References 31 publications

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“…In a subgroup of 43 patients with viable myocardium included in this study, we had previously shown that revascularization improved global LV ejection fraction by an average of 13%, a change that is likely to impact survival. 8 In contrast, in 30 patients with nonviable myocardium, revascularization did not result in any significant changes in global LV function and barely prevented LV dilatation. 8 Likewise, in the present study, revascularization had no major influence on long-term outcome in the absence of viable myocardium.…”

Section: Prognostic Implications Of Myocardial Ischemia and Viabilitymentioning

confidence: 81%

“…Until now, studies addressing the contribution of these techniques to the detection and treatment of viable myocardium have mainly concentrated on their ability to predict the return of contractile function after revascularization. [5][6][7][8] The purpose of the present study was to establish the potential prognostic implications of identifying viable and/or ischemic myocardium by either of these 2 methods in patients with LV ischemic dysfunction. The results can be summarized as follows:…”

Section: Discussionmentioning

confidence: 99%

“…The presence of viable myocardium was evaluated in our study by exercise-redistributionreinjection thallium scintigraphy and by low-dose dobutamine echocardiography. We and others [5][6][7][8][9][10][11] previously showed that both methods accurately predict the return of regional and global LV function after revascularization. The present study demonstrates that, in addition, these 2 methods also provide valuable prognostic information, with significant therapeutic implications.…”

Section: Prognostic Implications Of Myocardial Ischemia and Viabilitymentioning

confidence: 99%

“…8,11 Delineation of inducible ischemia with the 2 methods was performed using previously validated criteria. [11][12][13] Patients were considered to have inducible ischemia by thallium scintigraphy if their defect extent score decreased by Ͼ3 grades between exercise and redistribution.…”

Section: Cardiac Catheterizationmentioning

confidence: 99%

“…During the past decade, delineation of viable from nonviable myocardium has become the focus of considerable attention and has fostered the development of several new modalities aimed at predicting the return of LV function after revascularization. Among these modalities, exercise-redistribution-reinjection thallium scintigraphy [5][6][7][8] and low-dose dobutamine echocardiography [7][8][9][10][11] have recently emerged as safe, noninvasive, and accurate means of identifying viable myocardium. Although existing data suggest that both imaging modalities are useful for predicting the return of contractile function after revascularization, few data are currently available on their potential value for predicting long-term survival.…”

mentioning

confidence: 99%

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Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Pasquet¹,

Robert²,

D'hondt³

et al. 1999

Circulation

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155

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Background-Previous studies showed that thallium scintigraphy and dobutamine echocardiography were accurate, noninvasive ways of predicting contractile recovery after revascularization in patients with left ventricular (LV) dysfunction. However, the prognostic impact of such methods remains uncertain. Methods and Results-We prospectively studied 137 consecutive patients with coronary disease and LV dysfunction who underwent exercise-redistribution-reinjection thallium scintigraphy and dobutamine echocardiography to identify myocardial ischemia and viability. A total of 94 patients subsequently underwent revascularization, and 43 underwent medical treatment. The primary endpoint was cardiac mortality, and mean follow-up was 33Ϯ10 months. Twenty-four patients died of cardiac causes. By Cox's regression analysis, long-term survival was related to the extent of coronary disease, the presence of diabetes, type of treatment, the presence of ischemic myocardium as determined by thallium scintigraphy, and the presence of viable myocardium as determined by both tests. Three-year survival was greater in patients with ischemic myocardium (as determined by thallium scintigraphy) or viable myocardium (as determined by both tests) who underwent revascularization than in the other groups (Pϭ0.018 with thallium; PϽ0.001 with dobutamine). Subgroup analyses indicated that among patients with 1-or 2-vessel disease, only those with ischemic or viable myocardium improved survival after revascularization, whereas in patients with 3-vessel or left main diseases, revascularization always improved survival, albeit more in the presence of ischemic or viable myocardium. Conclusions-Among the parameters commonly available in patients with LV ischemic dysfunction, the presence of ischemic myocardium (as determined by thallium scintigraphy) and that of viable myocardium (as determined by dobutamine echocardiography) are independent predictors of subsequent mortality. These observations may be useful in the preoperative selection of patients for revascularization. (Circulation. 1999;100:141-148.)

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Section: Prognostic Implications Of Myocardial Ischemia and Viabilitymentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Prognostic Implications Of Myocardial Ischemia and Viabilitymentioning

confidence: 99%

Section: Cardiac Catheterizationmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Pasquet¹,

Robert²,

D'hondt³

et al. 1999

Circulation

Self Cite

155

View full text Add to dashboard Cite

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Recent advances in dobutamine stress echocardiography

Usher

O’Brien

2000

Clinical Cardiology

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Summary: Dobutamine stress echocardiography (DSE) is a reliable cardiac risk stratifier that has widespread applicability because of its clinical accuracy and cost effectiveness. Dobutamine has positive inotropic and chronotropic effects and is commonly used in patients who cannot exercise or achieve an adequate heart rate response with exercise. Recently available long-term results from several independent clinical trials, combined with enhancements in image quality, have improved the ability to detect significant coronary artery disease and determine myocardial viability. Dobutamine stress echocardiography has an excellent safety profile with clinical results superior to regular exercise electrocardiography and comparable with exercise echocardiography and radionucleotide perfusion stress imaging. Low-dose dobutamine response can accurately predict dysfunctional yet viable myocardial regions that may improve with revascularization. Clinical studies are now available refining the common use of DSE preoperatively in female patients with valvular disease, as well as in the emergency department. Dobutamine stress echocardiography does have some limitations in discriminating particular regions of ischemia when multiple ventricular segments are involved and when the imaging is suboptimal. It can be applied using minimal additional resources in an otherwise functioning echocardiography laboratory and, with appropriate training, can result in clinical results comparable with those of large-scale multicenter trials. Ongoing improvements in technology and the de- velopment of new reagents such as myocardial contrast agents hold promise for further advancement in the near future.

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Myocardial viability in patients with thrombolyzed myocardial infarction: Is it assessable by predischarge exercise electrocardiography test?

Samad

Jensen‐Urstad

Hulting

et al. 2001

Clinical Cardiology

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Background: Most studies concerning exercise electrocardiography (ECG) testing after acute myocardial infarction (AMI) were carried out in the prethrombolytic era. ST‐segment elevation in the infarction area during exercise has usually been interpreted as indicating the presence of dyskinesia as a result of extensive left ventricle damage. Hypothesis: This study was undertaken to evaluate the contributions of exercise‐induced ST‐segment elevation and T‐wave pseudonormalization to the assessment of myocardial viability in patients with thrombolyzed myocardial infarction (MI), compared with low‐dose dobutamine echocardiography. Methods: The study comprised 52 consecutive patients with AMI treated with thrombolysis. All patients underwent low‐dose dobutamine echocardiography and symptom‐limited exercise testing before discharge. Nineteen patients showed ST‐segment elevation (Group 1), 9 showed isolated T‐wave pseudonormalization (Group 2), and 24 patients did not exhibit either of these ST‐T segment changes (Group 3). Low‐dose dobutamine echocardiography revealed evidence of viability in 16 patients (84%) in Group 1 (p=0.01), 5 (56%) in Group 2 (p=NS), and 11 patients (46%) in Group 3 (p = NS). Conclusion: Exercise‐induced ST‐segment elevation may contribute to the evaluation of myocardial viability in patients with AMI treated with thrombolysis. However, in the absence of exercise‐induced ST‐segment elevation, further noninvasive studies might be indicated to assess myocardial viability.

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Head-to-head comparison of exercise-redistribution-reinjection thallium single-photon emission computed tomography and low dose dobutamine echocardiography for prediction of reversibility of chronic left ventricular ischemic dysfunction

Cited by 125 publications

References 31 publications

Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Prognostic Value of Myocardial Ischemia and Viability in Patients With Chronic Left Ventricular Ischemic Dysfunction

Recent advances in dobutamine stress echocardiography

Myocardial viability in patients with thrombolyzed myocardial infarction: Is it assessable by predischarge exercise electrocardiography test?

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