Prediction of long-term effects of revascularization on regional and global left ventricular function by dobutamine echocardiography and rest Tl-201 imaging alone and in combination in patients with chronic coronary artery disease

• Published in: Journal of nuclear cardiology 2002-03, Vol.9 (2), p.174-182
• Main Authors: Dellegrottaglie, Santo, Perrone-Filardi, Pasquale, Pace, Leonardo, Prastaro, Mariella, Della Morte, Anna Maria, Ponticelli, Maria Paola, Piscione, Federico, Storto, Giovanni, De Luca, Giuseppe, Salvatore, Marco, Chiariello, Massimo
• Format: Article
• Language: English
• Subjects: Accuracy; Adult; Aged; Cardiology; Cardiovascular disease; Chronic Disease; Coronary Disease - diagnostic imaging; Coronary Disease - physiopathology; Coronary vessels; Discriminant analysis; Dobutamine; Echocardiography, Stress; Ejection fraction; Female; Heart attacks; Humans; Male; Middle Aged; Myocardial Contraction - physiology; Myocardial Revascularization; Observer Variation; Recovery of Function; Sensitivity and Specificity; Stroke Volume - physiology; Thallium Radioisotopes; Tomography, Emission-Computed, Single-Photon; Vein & artery diseases; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - physiopathology
• ISSN: 1071-3581; 1532-6551
• DOI: 10.1067/mnc.2002.120162

Background. The aim of this study was to evaluate the accuracy of low-dose dobutamine echocardiography (DE) and resting thallium 201 single photon emission computed tomography (SPECT) alone and in combination for prediction of functional recovery at late follow-up (1 year) after revascularization. Methods and Results. Twenty-six patients with coronary artery disease and ventricular dysfunction (ejection fraction, 42% ± 9%) underwent DE and Tl-201 SPECT 14 ± 9 (mean ± SD) days before revascularization and repeated echocardiography 12 ± 5 months thereafter. Discriminant analysis was applied to combine Tl-201 SPECT and DE data to classify dysfunctional segments as viable or nonviable. In 78 akinetic/dyskinetic revascularized segments, Tl-201 SPECT provided a sensitivity of 83% and a specificity of 55%, whereas DE showed a sensitivity of 60% and a specificity of 91%, for prediction of improvement in regional function at follow-up. The combination of data through use of discriminant analysis provided a sensitivity of 80% and a specificity of 86%, with an overall accuracy of 82%, significantly higher than DE (71%; P < .05) and Tl-201 SPECT (73%; P < .05) alone. Moreover, discriminant analysis identified 12 (75%) of 16 patients with and 8 (80%) of 10 patients without significant improvement in ejection fraction at follow-up, with an accuracy of 77%. Conclusions. The combination of Tl-201 SPECT and DE data provides higher accuracy than either technique alone for prediction of recovery of regional and global function after revascularization. (J Nucl Cardiol 2002;9:174-82.)