ACCURACY OF DOBUTAMINE ECHOCARDIOGRAPHY FOR DETECTION OF MYOCARDIAL VIABILITY IN PATIENTS WITH AN OCCLUDED LEFT ANTERIOR DESCENDING CORONARY-ARTERY

Objectives. We studied the accuracy of dobutamine echocardiography for the detection of myocardial viability in patients with an occluded le ft anterior descending coronary artery and regional ventricular dysfun ction. Background. Contractile reserve during dobutamine echocar diogr aphy is an accurate marker of myocardial viability in pa tients with c oronary stenoses and ventricular dysfunction, However, its accuracy in patients with an occluded vessel has not been evaluated. Methods. We studied 41 patients with >50% stenosis of the left anterior descending coronary artery and regional ventricular dysfunction who underwent do butamine echocardiography for detection of viable myocardium, Contract ile reserve was defined as improvement in wall motion score of two or more contiguous septal or anterior segments during dobutamine echocard iography, Recovery of function was defined as improvement in rest wall motion score of two or more contiguous segments after revascularizati on. Results. Patients were classified into two groups according to the presence (n = 20) or absence (n = 21) of left anterior descending cor onary artery occlusion, Contractile reserve was detected in 40% of pat ients with an occluded and 43% with a nonoccluded artery (p = 0.8). Of 41 patients, 27 underwent revascularization, 12 with and 15 without a n occluded vessel, Recovery of function occurred in 6 (50%) of 12 pati ents in the occluded artery group and in 5 (33%) of 15 in the nonocclu ded artery group (p = 0.4), Among patients with an occluded artery, th e positive and negative predictive values of dobutamine echo cardiogra phy for recovery of function were 100% (95% confidence interval [CI] 4 8% to 100%) and 86% (95% CI 42% to 100%), respectively. Conclusions. O ur results indicate that contractile reserve during dobutamine echocar diography can be detected in patients with an occluded vessel and may be useful for predicting recovery of function after revascularization.