Identification of hibernating myocardium by dobutamine stress echocardiography: comparison with thallium-201
T Haque1, T Furukawa, M Takahashi
1First Department of Internal Medicine, Shiga University of Medical Science, Japan.
Insights
Dobutamine stress echocardiography (DSE) effectively identifies hibernating myocardium, aiding in selecting patients for coronary revascularization. It shows comparable predictive accuracy to thallium-201 reinjection (RI) imaging for myocardial viability.
Area of Science:
- Cardiology
- Nuclear Cardiology
- Diagnostic Imaging
Background:
- Coronary artery disease can lead to myocardial hibernation, a state of impaired contractility despite preserved viability.
- Accurate identification of hibernating myocardium is crucial for selecting appropriate candidates for revascularization procedures.
Purpose of the Study:
- To evaluate the diagnostic value of dobutamine stress echocardiography (DSE) in identifying hibernating myocardium.
- To compare the predictive accuracy of DSE with thallium-201 reinjection (RI) imaging for myocardial viability.
Main Methods:
- Dobutamine stress echocardiography (DSE) was performed on 26 patients with wall motion abnormalities.
- Thallium-201 reinjection (RI) imaging was used as a comparator for assessing myocardial viability.
- Sensitivity, specificity, and predictive values were calculated for both DSE and thallium-201 RI imaging.
Main Results:
- DSE correctly predicted postrevascularization improvement in 31 of 33 hibernating segments and identified 8 of 10 nonhibernating segments.
- Thallium-201 RI imaging showed high sensitivity (100%) but lower specificity (40%) when using a 50% uptake threshold.
- DSE demonstrated a sensitivity of 94% and specificity of 80% for identifying hibernating myocardium.
Conclusions:
- Dobutamine stress echocardiography (DSE) is a valuable tool for identifying hibernating myocardium.
- DSE offers a reliable alternative to thallium-201 imaging for assessing myocardial viability in patients with coronary artery disease.
- Findings support the use of DSE in guiding decisions for coronary revascularization.
Abstract:
The aim of this study was to determine the diagnostic value of dobutamine stress echocardiography (DSE) in the identification of hibernating myocardium and to compare its predictive accuracy with that of thallium-201 reinjection (RI) imaging. The subjects were 26 patients with wall motion abnormalities related to stenosed coronary arteries. DSE predicted postrevascularization improvement in 31 of 33 segments that were considered to be hibernating and identified 8 of 10 nonhibernating segments. In contrast, thallium-201 scintigraphy predicted all 33 hibernating segments when a post-RI myocardial thallium uptake in ischemic areas of > or = 50% of the maximum count in normal segments was used as a positive marker of myocardial viability. However, thallium studies predicted only 30 of 33 hibernating segments when thallium redistribution (RD) was used as a marker of viability in delayed or RI images. Among the 10 nonhibernating segments, an uptake of < 50% was observed in 4 segments and negative thallium-201 RD was observed in 5 segments. The sensitivity, specificity, and predictive values (PV) of DSE were 94%, 80%, positive PV 94%, and negative PV 80%, respectively. In contrast, the sensitivity, specificity, and PV of thallium-201 RI imaging were 100%, 40%, 85%, and 100% with uptake > or = 50% and 91%, 50% 86%, and 63% with RD, respectively. These results suggest that DSE may be useful for identifying hibernating myocardium and could therefore be helpful in selecting candidates for coronary revascularization.
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