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Titolo:
PREDICTION OF IMPROVEMENT OF REGIONAL LEFT-VENTRICULAR FUNCTION AFTERSURGICAL REVASCULARIZATION - A COMPARISON OF LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY WITH TL-201 SINGLE-PHOTON EMISSION COMPUTED-TOMOGRAPHY
Autore:
ARNESE M; CORNEL JH; SALUSTRI A; MAAT APWM; ELHENDY A; REIJS AEM; TENCATE FJ; KEANE D; BALK AHMM; ROELANDT JRTC; FIORETTI PM;
Indirizzi:
UNIV HOSP DIJKZIGT,THORAXCTR,DEPT CARDIOL,THORAXCTR BA 300,DR MOLEWATERPLEIN 40 3015 GD ROTTERDAM NETHERLANDS UNIV HOSP DIJKZIGT,THORAXCTR,DEPT CARDIOL 3015 GD ROTTERDAM NETHERLANDS UNIV HOSP DIJKZIGT,DEPT CARDIAC SURG 3015 GD ROTTERDAM NETHERLANDS UNIV HOSP DIJKZIGT,DEPT NUCL MED 3015 GD ROTTERDAM NETHERLANDS ERASMUS UNIV ROTTERDAM ROTTERDAM NETHERLANDS
Titolo Testata:
Circulation
fascicolo: 11, volume: 91, anno: 1995,
pagine: 2748 - 2752
SICI:
0009-7322(1995)91:11<2748:POIORL>2.0.ZU;2-H
Fonte:
ISI
Lingua:
ENG
Soggetto:
CORONARY-ARTERY DISEASE; ACUTE MYOCARDIAL-INFARCTION; STRESS ECHOCARDIOGRAPHY; VIABLE MYOCARDIUM; THROMBOLYTIC THERAPY; NUCLEAR CARDIOLOGY; MEDICAL PROGRESS; IDENTIFICATION; VIABILITY; INFUSION;
Keywords:
DOBUTAMINE; MYOCARDIUM; BYPASS; ECHOCARDIOGRAPHY; SCINTIGRAPHY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
19
Recensione:
Indirizzi per estratti:
Citazione:
M. Arnese et al., "PREDICTION OF IMPROVEMENT OF REGIONAL LEFT-VENTRICULAR FUNCTION AFTERSURGICAL REVASCULARIZATION - A COMPARISON OF LOW-DOSE DOBUTAMINE ECHOCARDIOGRAPHY WITH TL-201 SINGLE-PHOTON EMISSION COMPUTED-TOMOGRAPHY", Circulation, 91(11), 1995, pp. 2748-2752

Abstract

Background Although both Tl-201 scintigraphy and low-dose dobutamine echocardiography (LDDE) have been proposed as effective methods of assessing myocardial viability, their relative efficacies are unknown. The aim of the present study was to compare the two imaging techniques in the prediction of improvement of regional left ventricular (LV) function after surgical revascularization. Methods and Results Thirty-eight patients with severe chronic LV dysfunction (ejection fraction less than or equal to 40%, one or more akinetic [Ak] or severely hypokinetic [SH] segments on resting echocardiogram) who underwent uncomplicatedcoronary artery bypass graft surgery were studied with simultaneous dobutamine stress echocardiography and poststress reinjection Tl-201 single-photon emission computed tomography (SPECT) before surgery. The Ak or SH segments were considered viable by LDDE when wall thickening improved during the infusion of 10 mu g . kg(-1). min(-1) dobutamine. Scintigraphic definition of viability was the presence of normal Tl-201uptake, totally reversible defect, partially reversible defect, or moderately severe fixed defect. The postoperative improvement of dyssynergic segments was determined with a rest echocardiogram 3 months aftersurgery. Of 608 LV segments, 169 were classified as Ak and 51 as SH on resting preoperative echocardiography. Of these, 170 were successfully revascularized. Wall motion during LDDE improved in 33 severely dyssynergic segments and was more frequent in SH than in Ak segments (19 of 44 versus 14 of 126, P<.0001). Viability was detected by Tl-201 SPECT criteria in 103 SH or Ak segments. Thirty-two of the 33 segments from LDDE responders were judged viable on Tl-201 SPECT, whereas Tl-201 viability was also detected in 71 of 137 segments from LDDE nonresponders. The sensitivity and the specificity for the prediction of postoperative improvement of segmental wall motion were 74% (95% confidence interval [CI], 67% to 81%) and 95% (95% CI, 92% to 98%) by LDDE and 89%(95% CI, 84% to 94%) and 48% (95% 40% to 56%) by Tl-201 SPECT, respectively. Positive predictive value of LDDE was higher than that of Tl-201 SPECT (85%, [95% CI, 80% to 90%] versus 33% [95% CI, 26% to 40%]). Thirty-six patients had angina before and only 1 had angina 3 months after revascularization. High-dose dobutamine echocardiography demonstrated significant reduction in stress-induced ischemia (new or worsening of preexisting wall motion abnormalities) after surgery (from 163 to23 LV segments). Conclusions In patients with severe chronic LV dysfunction, LDDE is a good predictor of the improvement of dyssynergic segments after revascularization. Because Tl-201 SPECT overestimates the probability of postoperative improvement of dyssynergic segments, LDDEshould be the preferred imaging technique for preoperative assessmentof these patients.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 25/01/20 alle ore 19:17:17