[Dobutamine stress thallium myocardial scintigraphy compared with two-dimensional echocardiography]

To assess the relationships among wall motion abnormality, myocardial ischemia and ST change in patients with myocardial infarction (MI), dobutamine stress thallium (Tl) myocardial scintigraphy, and two-dimensional echocardiography (2DE) and electrocardiography were simultaneously performed. Sixteen patients with anterior MI who underwent 2DE and ECG were studied at baseline and during dobutamine infusion with incremental doses of two to 40 micrograms/kg/min. The stress endpoints were chest pain, significant ST changes, tachycardia (greater than or equal to 110/min), and complicated arrhythmias. At the maximal tolerable dose of dobutamine, Tl scintigraphy was completed, and then repeated again four hours later. Left ventricular wall motion was evaluated using superimposed wall tracings of the configuration on 2DE, and was expressed as regional % area changes. Myocardial ischemia was quantified by SPECT and measured as regional % Tl uptake. Dobutamine stress testing was well tolerated by all patients, and no complications occurred. Hemodynamic changes included: heart rate increased from 61 +/- 9 to 113 +/- 11 beats/min, left ventricular end-diastolic volume (2DE) decreased from 93 +/- 27 to 59 +/- 33 ml, and mean blood pressure and ejection fraction were unchanged. In 11 of the 16 patients, redistributions on planar and SPECT images were observed. Although redistributions were observed in the areas adjacent to infarcts in patients with significant ST elevation in V3, additional wall motion abnormalities were not observed. The shape of the ST elevation had no relation to myocardial ischemia. In some cases, wall motion abnormality can be improved in spite of ischemia. Thus, this new combined method is useful for evaluating the relationship between ischemia and wall motion dynamics.