Low dose dobutamine echocardiography for predicting functional recovery after coronary revascularisation
F Piscione1, P Perrone-Filardi, G De Luca
1Division of Cardiology, Federico II University, Via Sergio Pansini 5, I-80131 Naples, Italy.
Insights
Low dose dobutamine echocardiography is less accurate in predicting myocardial recovery in patients with totally occluded coronary arteries. Caution is advised when using this viability assessment for selecting patients for revascularisation.
Area of Science:
- Cardiology
- Echocardiography
- Myocardial Viability Assessment
Background:
- Assessing myocardial viability is crucial for guiding revascularisation decisions in patients with coronary artery disease.
- Low dose dobutamine echocardiography is a common method to predict myocardial recovery after revascularisation.
Purpose of the Study:
- To evaluate the impact of chronic coronary occlusion on the accuracy of low dose dobutamine echocardiography in predicting myocardial recovery.
- To compare the predictive accuracy in patients with occluded versus non-occluded coronary arteries.
Main Methods:
- Retrospective study of 53 patients with left anterior descending coronary artery (LAD) stenosis and regional dysfunction.
- Patients were divided into non-occluded LAD (Group 1) and occluded LAD (Group 2) groups.
- Low dose dobutamine echocardiography was performed before revascularisation (coronary artery bypass grafting or percutaneous transluminal coronary angioplasty), with echocardiography repeated post-revascularisation.
Main Results:
- Myocardial recovery occurred in 43% of segments in Group 1 and 46% in Group 2.
- Sensitivity, negative predictive value, and accuracy of dobutamine echocardiography were significantly higher in Group 1 (non-occluded LAD) compared to Group 2 (occluded LAD).
- Specifically, sensitivity was 87% vs 52%, NPV 88% vs 65%, and accuracy 77% vs 64% (p < 0.01 for all comparisons).
Conclusions:
- Low dose dobutamine echocardiography demonstrates reduced sensitivity in predicting recovery of dysfunctional myocardium supplied by totally occluded coronary arteries.
- Clinical decisions regarding revascularisation based on this viability assessment in patients with occluded vessels should be made with caution.
Objective:
To evaluate the effects of chronic coronary occlusion on the accuracy of low dose dobutamine echocardiography in predicting recovery of dysfunctional myocardium after revascularisation.
Design:
Retrospective study.
Setting:
Tertiary referral centre.
Patients:
53 consecutive patients with >/= 70% stenosis of the left anterior descending coronary artery (LAD) and regional ventricular dysfunction (group 1, non-occluded LAD; group 2, occluded LAD) who underwent dobutamine echocardiography.
Interventions:
26 patients underwent coronary artery bypass grafting and 27 had percutaneous transluminal coronary angioplasty.
Main Outcome Measures:
Baseline studies before revascularisation included cross sectional echocardiography at rest and during dobutamine infusion (5-10 microgram), and coronary angiography. The dobutamine study was performed mean (SD) 35 (28) days before revascularisation. Echocardiography at rest was repeated 90 (48) days after revascularisation.
Results:
Of 296 dysfunctional segments, 63 in group 1 (43%; 63/146) and 69 in group 2 (46%; 69/150) (NS) improved at follow up. Mean (SD) regional wall motion score index decreased from 1.97 (0.48) (95% confidence interval (CI) 1.01 to 2.93) before revascularisation to 1.74 (0.52) (95% CI 0.70 to 2.78) at follow up in group 1 (p = 0.001), and from 2.12 (0.41) (95% CI 1.30 to 2.98) to 1.88 (0.36) (95% CI 1.16 to 2.60) in group 2 (p = 0.0006). In group 1, sensitivity (87% v 52%; p < 0.0001), negative predictive value (88% v 65%; p = 0.001), and accuracy (77% v 64%; p = 0.01) were all significantly higher than in group 2, despite the angiographic evidence of collaterals in patients with occluded vessels.
Conclusions:
Dobutamine echocardiography shows reduced sensitivity in predicting recovery of dysfunctional myocardium supplied by totally occluded vessels. Thus caution should be used in selecting such patients for revascularisation on the basis of a viability assessment made in this way.
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