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Assessment of left ventricular function using dobutamine stress echocardiography and myocardial scintigraphy in
1Department of Surgery, Kobe University School of Medicine.
Insights
Preoperative dobutamine stress echocardiography effectively predicts left ventricular function after valvular heart surgery. Myocardial scintigraphy also offers insights into ventricular function in these patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Diagnostic Imaging
Background:
- Valvular heart disease can impair left ventricular (LV) function.
- Assessing preoperative LV function is crucial for surgical outcomes.
Purpose of the Study:
- To evaluate the predictive value of dobutamine stress echocardiography and myocardial scintigraphy for postoperative LV function in valvular heart disease patients.
Main Methods:
- Retrospective analysis of 37 patients with preoperative LV dysfunction (≤25% fractional shortening).
- Comparison of patients with improved (%FS) versus deteriorated LV function post-surgery.
- Assessment using dobutamine stress test (delta %FS) and myocardial scintigraphy (Defect Score).
Main Results:
- A delta %FS >9% predicted improved LV function post-operation (Group A).
- A delta %FS <9% was associated with deteriorated LV function or failure (Group B).
- Myocardial scintigraphy showed significant differences in Defect Scores between patients with LV dysfunction and controls, with defects often in posterior/inferior segments.
Conclusions:
- Dobutamine stress echocardiography is a valuable tool for predicting postoperative LV function in valvular heart disease.
- Myocardial scintigraphy may also indicate LV function status in this patient population.
Abstract:
To assess the left ventricular (LV) function in valvular heart disease, we employed the preoperative dobutamine stress echocardiography and the myocardial scintigraphy. During the past 13 years, 37 of 324 the patients showed LV dysfunction with the % fractional shortening (%FS) of 25% or less in the preoperative echocardiogram. These patients were retrospectively divided into two groups; Group A (n = 21): %FS has improved late after operation; Group B (n = 16): %FS has deteriorated or LV failure occurred. The mean follow-up period was 84 +/- 54 months after valve surgery. No significant differences were observed in the preoperative characteristics and operative variables between these two groups. The dobutamine stress test had been performed in 8 patients in Group A and 9 patients in Group B preoperatively, and the maximum increase ratio of %FS (delta %FS) was used for assessment. Seven patients in Group A had showed delta %FS of more than 9%, while all patients in Group B had showed delta %FS of less than 9%. Myocardial scintigraphy was performed in 11 patients of them, and another 22 patients with %FS of above 25% acted as the control group. The Defect Score, which was defined as the sum of defect scales in 25 LV segments, showed a significant difference between 11 patients with LV dysfunction and control group. The distribution of the Defect Score in each myocardial segment, showed significantly higher in the posterior and inferior LV segments. In addition, the perfusion defect on myocardial imaging was initiated in the junction between the septal and LV free wall, and extended from the posterior to the lateral wall along with deterioration of LV function. In conclusion, preoperative dobutamine stress echocardiography proved to be very useful for prediction of the postoperative LV function, and myocardial scintigraphy might be indicative of LV function even in valvular heart disease.